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HEALTH SCIENCES LIBRARY
OF THE
UNIVERSITY OF NORTH CAROLINA
This Book Must Not Be Taken
from the Division of Health
Affairs Buildings. F0UR DAYS
This JOURNAL may be kept oul
and is subject to a fine of FIVE CENTS a day
thereafter. It is DUE on the DAY indicated
below:
Pictures and Personal Sketches of 10 Outstanding Persons
Honored for their contributions to Medical Science.
Modern Medicine's
1965 Distinguished Achievement Awards
(see following pages)
To the men who make the great discoveries in medical
science, to the men who apply them in practice, and to their
teachers, Modern Medicine is privileged to say "well done"
on behalf of the medical profession. The nominations for
the Awards for Distinguished Achievement come from deans
of medical schools, leaders of medical organizations, and
members of the Modern Medicine editorial board. No honor
has a merit higher than the merit of those who wear it, and
this award has taken its luster from the names and achieve-ments
of the men who have won it over the years.
Reprinted with permission from Modern Medicine, the Journal of Diagnosis
and Treatment, (January 4, 1965). Copyright 1965 by Modern Medicine
Publications, Inc.
The Health Bulletin MARY ANN farthing, m.s.
Jacob Koomen, Jr., M.D., M.P.H.
First Published—April 1886 Bryan Reep M.S.
The official publication of the North Carolina
State Board of Health, 608 Cooper Memorial Health
Building, 225 North McDowell Street, Raleigh, N. C. John Andrews, B.S.
Published monthly. Second Class Postage paid at Glenn A. Flinchum, B.S.
Raleigh, N. C Sent free upon request. H. W. STEVENS, M.D.. M.P.H.. ASHEVILLE
EDITORIAL BOARD
Charles M. Cameron, Jr , M.D., M.P.H.
Chapel Hill
John T. Hughes, D.D.S., M.P.H.
John C. Lumsden, B.C.H.E.
Editor-Edwin S. Preston, M.A., LL.D.
Vol. 80 January, 1965 No. 1
THE HEALTH BULLETIN January, 1965
Ten
Outstanding
Physicians
and
Medical
Scientists
Honored
for
Contributions
to
Medical
Science
Photographs and discussion
on following pages
Special recognition for their contribu-tions
to medical science was given this
year to 10 outstanding physicians and
medical scientists as the Editors of
Modern Medicine announced their 1965
Distinguished Achievement Awards.
Nine men and one woman were se-lected
from over 100 outstanding med-ical
leaders nominated by deans of
U. S. medical schools, leaders of pro-fessional
medical organizations and
members of the Modern Medicine edi-torial
board. The announcement of the
awards was made in the January 4 is-sue
of the journal.
January, 1965 THE HEALTH BULLETIN
Initiated in 1934, the Modern Medi-cine
annual awards honor those of the
medical profession who make great and
continuing discoveries in medicine. The
1965 winners join the 280 distinguished
physicians and scientists who have re-ceived
the awards during the past 30
years.
The 1 965 winners are:
Leona Baumgartner, M.D., assistant
administrator for technical cooperation
and research, Agency for International
Development, Washington, D. C, for
her concern with the health of man
manifested by contributions to public
health as a scientist and administrator
in an increasing sphere of influence.
Oscar Creech, Jr., M.D., professor of
surgery and chairman of the department
of surgery, Tulane University, New Or-leans.
Dr. Creech was cited for his de-velopment
of regional perfusion in the
treatment of malignant diseases and
for the impact of his work on cardio-vascular
surgical techniques.
Derek E. Denny-Brown, M.D., profes-sor
of neurology, Harvard University,
and director, neurological unit, Boston
City Hospital. Dr. Denny-Brown was
honored for his application of the ac-cumulated
knowledge in basic biolog-ical
sciences to the elucidation of ob-scure
neurological disorders, giving
hope for their ultimate control.
A. Baird Hastings, Ph.D., professor of
biological chemistry, emeritus, Harvard
University, and head of the laboratory
of metabolic research, Scripps Clinic
and Research Foundation, La Jolla, Cali-fornia.
Dr. Hastings received the award
for his brilliant and imaginative discov-eries
in biochemistry, coupled with a
practical approach to their clinical use,
and for his influence as a gifted teacher.
Hudson Hoagland, Ph.D., executive
director of the Worcester Foundation
for Experimental Biology, Shrewsbury,
Mass. He was selected for his organi-zation
of an outstanding biomedical re-search
institution and for his work as
a scientist and a humanitarian bearing
on the world's problem of an exploding
population.
Chester S. Keefer, M.D., professor of
medicine, Boston University, Boston,
was cited for broad talents as clinician,
investigator, educator, and administrator
that have significantly bettered medical
teaching and practice.
William J. Kolff, M.D., head of the
department of artificial organs, Cleve-land
Clinic, and professor of experiment-al
medicine, Cleveland Clinic Educa-tional
Institute. Dr. Kolff was singled
out for his development of practical
methods for effective hemodialysis and
for investigation and development of
mechanical substitutes for essential bio-logical
structures.
Joseph L. Melnick, Ph.D., chairman of
virology and epidemiology, Baylor Uni-versity,
Houston, was chosen for his
work in basic virology especially with
the enteroviruses, and the development
of methods of stabilizing the poliomye-litis
virus that enhance the safety of
poliomyelitis vaccine.
John P. Merrill, M.D., director, cardio-renal
section of Peter Bent Brigham
Hospital, and associate clinical profes-sor
of medicine, Harvard University,
Boston. Dr. Merrill was honored for
pioneering in tissue transplantation and
scientific studies of compatibility factors
that have provided a biologically sound
approach to kidney transplantation.
Francis D. Moore, M.D., professor of
surgery, Harvard Medical School, and
surgeon-in-chief, Peter Bent Brigham
Hospital, Boston. He received the award
for extensive work on the basic patho-physiology
of the surgical patient that
has widened the surgeon's scope, im-proved
operative results, and promoted
the patient's comfort.
THE HEALTH BULLETIN January, 1965
LEONA BAUMGARTNER, M.D.
concern with the health of man manifested by contributions to public health
as a scientist and administrator in an increasing sphere of influence
Assistant administrator for technical co-operation
and research, Agency for In-ternational
Development, Washington,
D. C.
January, 1965 THE HEALTH BULLETIN
OSCAR CREECH, JR., M.D
development\of regional perfusion for the treatment of malignant disease
and impact on cardiovascular surgical techniques
William Henderson professor of surgery
and chairman of the department of sur-gery,
Tulane University, New Orleans.
THE HEALTH BULLETIN January, 1965
S&*v^Sfe
liii \
DEREK DENNY-BROWN, M.D.
application of the accumulated knowledge in basic biological sciences to
the elucidation of obscure neurological disorders, giving hope for their
ultimate control
James Jackson Putnam professor of
neurology, Harvard University, and di-rector,
neurological unit, Boston City
Hospital.
January, 1965 THE HEALTH BULLETIN 7
A. BAIRD HASTINGS, Ph.D.
brilliant and imaginative discoveries in biochemistry, coupled with a prac-tical
approach to their clinical use, and influence as a gifted teacher
-*>-.*:«rv.:'-=i3
Hamilton Kuhn professor of biological
chemistry, emeritus, Harvard University,
Boston, and head of the Laboratory of
Metabolic Research, Scripps Clinic and
Research Foundation, La Jolla, Calif.
THE HEALTH BULLETIN January, 1965
HUDSON HOfGLAND, Ph.D.
organization of an (outstanding biomedical research institution and work as
a scientist and a humanitarian bearing on the world's problem of an ex-ploding
population
•
Executive director, Worcester Founda-tion
for Experimental Biology, Shrews-bury,
Mass.
January, 1965 THE HEALTH BULLETIN
CHESTER S. KEEFER, M.D.
protean talents as clinician, investigator, educator, and administrator that
have significantly bettered medical teaching and practice
Wade professor of
University.
ledicine, Boston
10 THE HEALTH BULLETIN January, 1965
WILLEM J. KOLFF, M.D.
practical methods for effective hemodialysis and investigation and develop-ment
of mechanical substitutes for essential biological structures
Head of the department of artificial or-gans,
Cleveland Clinic, and professor
of experimental medicine, Cleveland
Clinic Educational Institute.
January, 1965 THE HEALTH BULLETIN 11
JOSEPH L MELNICK, Ph.D.
work in basic virology, especially with the enteroviruses, and development
of methods of stabilizing the poliomyelitis virus that enhance the safety
of poliomyelitis vaccine
Chairman, department of virology and
epidemiology, Baylor University, Hous-ton.
12 THE HEALTH BULLETIN January, 1965
JOHN P. MERRILL, M.D.
pioneering in tissue transplantation and scientific studies of compatibility
factors that have provided a biologically sound approach to kidney trans-plantation
Director, cardiorenal section, Peter Bent
Brigham Hospital, and associate clinical
professor of medicine, Harvard Univer-sity,
Boston.
January, 1965 THE HEALTH BULLETIN 13
FRANCIS D. MOORE, M.D.
extensive work on the basic pathophysiology of the surgical patient that
has widened the surgeon's scope, improved operative results, and pro-moted
the patient's comfort
Moseley professor of surgery, Harvard
University, and surgeon-in-chief, Peter
Bent Brigham Hospital, Boston.
14 THE HEALTH BULLETIN January, 1965
Individual Air Conditioners
Are Being Used
An individual air conditioner provid-ing
cool, clean air for workers exposed
to heat is being used routinely on cer-tain
jobs in industrial plants in the
southern United States.
The simple, low-cost device is de-scribed
by W. F. Lienhard, M.D., San
Diego, Calif., J. P. Hughes, M.D., Oak-land,
Calif., and T. A. Brassette, AA. E.,
New Orleans, in the current (September)
Archives of Environmental Health, pub-lished
by the American Medical Asso-ciation.
It could be particularly helpful for
workers whose tolerance for heat has
been reduced by aging, heart disease,
or other physiological impairment.
Comparable observations on acclima-tized
workmen with and without the de-vice
during periods of identical work in
a severely hot environment resulted
in a threefold reduction in heat loss, a
25 per cent reduction in total heart
beat, and a 50 per cent reduction in
the rate of body temperature rise for
the air-conditioned man, according to
the researchers.
The entire weight of the personal air-conditioner
is only 19 ounces, accord-ing
to the report. The air is cooled
by a vortex tube, invented in 1931 by
a French metallurgist, George Ranque.
Standard industrial compressed air is
delivered through a hose to the tube
attached by a belt to the man's waist.
The tube converts compressed air at
120 degrees Fahrenheit to a steady
flow at 65 F.
Each worker has a "breakaway" coup-ling
so he can detach himself from the
air supply hose simply and quickly in
case of danger. Hoses 150 feet in
length provide the worker a high de-gree
of mobility.
None of the earlier systems proposed
for individual air conditioning has been
widely adopted in industry because
in general they have been too complex
and too costly for day-to-day use on
most jobs, the researchers commented.
Vortex tube units with accessory equip-ment
are commercially available. The
vortex tube alone costs less than $75.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
Lenox D. Baker, M.D., President Durham
John R. Bender, M.D., Vice-President Winston-Salem
Ben W. Dawsey, D.V.M Gastonia
Glenn L. Hooper, D.D.S. Dunn
Oscar S. Goodwin, M.D. Apex
D. T. Redfearn, B.S. Wadesboro
James S. Raper, M.D. Asheville
Samuel G. Koonce, Ph.G. Chadbourn
John S. Rhodes, M.D. Raleigh
EXECUTIVE STAFF
J. W. R. Norton, M.D., M.P.H. State Health Director
Jacob Koomen, Jr., M.D., M.P.H. Assistant State Health Director
J. M. Jarrett, B.S. Director, Sanitary Engineering Division
Martin P. Hines, D.V.M., M.P.H. Director, Epidemiology Division
W. Burns Jones, M.D., M.P.H. Director, Local Health Division
E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division
Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division
Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services J>iri
James F. Donnelly, M.D. Director, Personal Health Division
January, 1965 THE HEALTH BULLETIN 15
THE HEALTH BULLETIN
P. O. Box 2091
Raleigh, N. C. 27602
LIBRARIAN
DIVISION OF HEALTH APTAl
N.C. ,VEM. ffOSP. U. M CHAPEL HILL, N.C.
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letin, please check here
GOdfiM
Official Publication Of The North Carolina Stare Board of Health
j^A***
John Atkinson Ferrell, M.D., Dr.P.H.
December 14, 1880 - February 17, 1965
Fe,b, fits'
John A. Ferre
The miraculous advance in a man's lifetime in public health in North Carolina
and the world could be no better marked than by the service of Dr. John A. Ferrell
who died here Wednesday night. He was, of course, as State Health Officer Dr.
Roy Norton said, "one of the outstanding physicians of all time native to North
Carolina." Perhaps the mark of his greatness was that in his quiet, useful, elder
years here, as director of the State Medical Care Commission, many of the health
dangers he confronted as a young man had all but disappeared.
He was only a young Duplin County practitioner in his twenties when in the
first decade of this century he became assistant State Health officer concerned
with combatting such plagues as typhoid fever and hookworm. Not everybody
approved when, working with the Sanitary Commission and the Rockefeller
Foundation, he extended his work in the campaign against hookworm. Some
Southern patriots resented statements that much backwardness in the South
resulted from this parasite which attacked so many rural people. Some con-sidered
the statements Yankee-financed slander. But understanding grew as health
conditions improved. And Dr. Ferrell was called from the State by the Rocke-feller
Foundation to carry the work to the world.
That work would have been enough to place him in the company of the
great physicians. But North Carolina was blessed when, as native after what
might have been time for retirement, he returned to the State of his youth to
help shape and direct Federal and State programs for hospital expansion in
North Carolina. His was a long life filled with great service. He deserves re-membrance
as one of the truly eminent men produced by North Carolina in this
century.
Editorial, Feb. 20, 1965, Raleigh New and Observer
THE HEALTH BULLETIN February, 1965
Dr. Ferrell's
Three
Public Health
Careers
Come
to an
End
Dr. John A. Ferrell, public health
pioneer, died late Wednesday night,
February 17, at Rex Hospital in Raleigh.
Funeral services were conducted at
11:30 a.m. on Friday, February 19, at
the Church of the Good Shepherd. The
Rev. James Beckwith and the Rev. Louis
Melcher officiated, and burial was at
3:30 p.m. in Elmwood Cemetery in
Charlotte.
John Atkinson Ferrell, physician and
public health administrator, was born
at Clinton, N. C, December 14, 1880,
son of James Alexander and Cornelia
(Murphy) Ferrell. His father (1832-1923)
was a merchant-farmer; his mother was
a daughter of Hanson Finla Murphy,
M.D., of Pender County, N. C.
The family has been in North Caro-lina
since colonial times, the earliest
known representative of the line being
Rev. James Alexander Ferrell, a Baptist
clergyman of Orange County, N. C, in
the eighteenth century. From him the
descent is traced through Anderson
(1804-43) and Mary (Dixon) Ferrell,
parents of James A. Ferrell, 2d.
The maternal line also runs into
colonial times, from Finla Murphy, who
came from Arrau Island, Scotland, in
1747, through Hugh Murphy of New
Hanover County, N. C, and his wife
Catherine McMillan; through Cornelius
and Catherine Murphy and Doctor Han-son
Finla and Elizabeth Anne (Simpson)
Murphy.
Dr. Ferrell was educated in the Uni-versity
of North Carolina, where he was
graduated B.S., in 1902; and M.D., in
1907. Later, in 1919, Dr. Ferrell was
graduated with the degree Dr. P.H.
(Doctor of Public Health) by Johns
Hopkins University School of Hygiene
and Public Health, the first occas.on on
which this institution conferred this de-gree
and he was the one and only
graduate that year.
For three years, (1902-05), he was
engaged in teaching and as superinten-dent
of schools in Sampson County,
N. C, and, during this time, entered
upon the study of medicine.
He began practice in Kenansville,
N. C, in 1907 and, in the same year,
was made superintendent of health of
Duplin County.
In 1909 John D. Rockefeller provided
the funds for the control in the South
of hookworm disease, which had been
found so prevalent as to become a
menace to the social and economic
progress of that area. The Rockefeller
Sanitary Commission was formed to
carry out the purpose of the benefac-tion
and Doctor Ferrell was chosen,
early in 1910, to have direction of ed-ucational
and control measures in
North Carolina with the title of As-sistant
Secretary of the State Board of
Health.
Although the disease, except among
physicians, was little known, his pione-ering
efforts resulted, during the period
1910-1913, in educating the people
throughout the State regarding the dis-ease,
its mode of spread and methods
February, 1965 THE HEALTH BULLETIN
for its prevention and cure, and in the
microscopic examination of 320,872
persons, of whom 160,689 were found
to be infected and were treated.
Upon the organization in 1913 of the
International Health Board of the Rocke-feller
Foundation, to extend throughout
the world such health work as had been
conducted by the Rockefeller Sanitary
Commission in the South and also to
embrace activities in the whole field of
public health, Dr. Ferrell was made Di-rector
for the United States. In this, he
directed the work which involves the
giving of financial aid and counsel
to official health agencies for the de-velopment
of essential branches of the
State services and also the develop-ment
of county organizations on a per-manent
basis. During his period of serv-ice,
331 full-time county organizations
were established, toward 226 of which
the Foundation contributed directly.
Dr. Ferrell, although active in the
general field of public health, featured
the strengthening of the State Health
Departments and especially the estab-lishment,
development and extension
of county health service.
In the United States, the Foundation
provided aid for training of more than
200 medical health officers to occupy
directive positions in the official health
agencies (1919-27).
As Associate Director of Internation-al
Health for the Rockefeller Founda-tion,
Dr. Ferrell directed this Founda-tion's
interests in the United States,
Canada and Mexico until 1944. From
1944 to 1946, he served as Medical
Director of the John and Mary R. Markle
Foundation.
On October 1, 1946, he began a
span of over ten years as Executive
Secretary of the North Carolina Medical
Care Commission. In this position, he
directed the use of Hill-Burton funds in
this State in the construction of 127
hospitals with an overall capacity of 6,-
567 beds, 41 nurses' residences, 3
diagnostic and treatment centers and 76
health centers— a total of 247 health
projects involving an expenditure of
$95,931,033.
He retired February 1, 1957, and he
and his wife had been living in Raleigh,
North Carolina, since that time.
His activity in professional organiza-tions
is illustrated by his membership
in the American Medical Association
(Chairman, Public Health Service, 1922-
23), the American Public Health As-sociation
(Member of Council 1 926-
29), the Southern Medical Association,
the North Carolina State Medical So-ciety
(Secretary, 1911-13), the New
Jersey State Medical Society, the Na-tional
Malaria Committee (Chairman,
1924), and the Royal Society of Public
Health.
The University of North Carolina gave
to Dr. Ferrell its Distinguished Service
Award.
He was the author of numerous
The Health Bulletin
First Published—April 1886
The official publication of the North Carolina
State Board of Health. 608 Cooper Memorial Health
Building, 225 North McDowell Street, Raleigh, N. C.
Published monthly. Second Class Postage paid at
Raleigh, N. C. Sent free upon request.
EDITORIAL BOARD
Charles M Cameron, Jr., M.D., M.P.H
Chapel Hill
John T. Hughes, D.D.S., M P H.
John C. Lumsden. B.C.H.E.
Mary Ann Farthing. MS.
Jacob Koomen. Jr., M.D . M PH.
Bryan Reep, MS.
John Andrews. B.S
Glenn A. Flinchum, B.S.
H. W. Stevens. M.D., M.P.H., Asheville
Editor— Edwin S. Preston, M.A., LL.D.
Vol. 80 February, 1965 No. 2
THE HEALTH BULLETIN February, 1965
papers and booklets on public health
subjects, among which are: "Medical In-spection
of Schools and School Chil-dren"
(1912); "Malaria of the South"
(1924); "Careers in Public Health"
(1923); "Health in Relation to Citizen-ship"
(1924); "Trend of Preventive
Medicine" (1923); "The Public Health
Nurse and County Health Service"
(1926); "The County Health Organi-zation
in Relation to Maternity and In-fancy
Work and Its Permanency" (1927);
"Survey of Provincial and State Health
Organizations"—with aid of staff—
(1927) etc.
Dr. Ferrell was married January 28,
1909 to Lucile Devereaux Withers,
daughter of Benjamin F. Withers of
Charlotte, N. C. They had one daugh-ter,
Bettie Devereaux, and two sons,
John Atkinson, Jr. and Benjamin With-ers
(deceased).
In tribute to Dr. Ferrell, Dr. J. W. R.
Norton, State Health Director, said, "He
was one of the outstanding physicians
of all time native to North Carolina. His
work here in early public health in the
control of hookworm and typhoid set
an example for the control of many
other communicable diseases. His in-ternational
service with the Rockefeller
Foundation and his service with the
John and Mary R. Markle Foundation
made him uniquely qualified to direct
the N. C. Medical Care Commission. In
that responsibility he set a pattern for
the ideal use of Hill-Burton funds in the
development of the best hospital plan-ning
and health center construction to
be found in the nation."
Death of Doctor Recalls Fight
Hookworms Once Plagued Tar Heels
by Bob Brooks
Raleigh News and Observer
Only the oldtimers remember the
campaign to stamp out hookworm dis-ease
in North Carolina.
It started in 1910, when a hardy
bunch of pioneers in public health
armed themselves with microscopes
and began probing the "stools" of
school children and adults over the
state.
By slow train, buggy and horseback
Dr. John A. Ferrell and his associates
went into every county in a hookworm
search that marked the beginning of ac-tive
public health work in this State.
Real Giant
Dr. Ferrell's death here last month
at 84 took from the State one of its real
giants in the public health field. His
direction of the hookworm control cam-paign,
as assistant secretary of the State
Board of Health, may have been his
most notable contribution.
It was a campaign which for the
first time focused the Tar Heel public's
attention on community-wide detection,
cure and prevention of communicable
diseases. Dr. Ferrell and his men con-ducted
lectures on sanitation and per-sonal
hygiene wherever they went.
The hookworm, in the early years
of this century, was a plague upon the
rural South. The small worm attaches it-self
to the lining of the upper part of
the small bowel and sucks blood from
its victim. An infected person may have
several thousand worms in him.
Rockefeller money helped in financ-ing
the State's effort to wipe out
February, 1965 THE HEALTH BULLETIN
hookworm disease. The work was di-rected
through the Rockefeller Sanitary
Commission. Dr. Ferrell was the com-mission's
State director. He had six field
directors.
Local governments were required to
provide part of the cost. Their efforts
at fighting hookworm on a matching
fund basis led to the organization of
local health departments.
In the beginning, there was some-thing
less than enthusiastic public ac-ceptance
of "the hookworm theory."
Some of the newspapers in the State re-ferred
to hookworm infection as "the
lazy disease" and "the fad."
Hookworm in the larvel stage may
enter the body through the thin skin
between the fingers and toes.
Having been given this knowledge,
some folks said Rockefeller was going
into the shoe business and the hook-worm
campaign was a scheme to get
southerners to wear shoes the year
round.
The News and Observer commented
that "many of us in the South are get-ting
tired of being exploited by ad-vertisements
that exaggerate condi-tions."
But the press and the people rallied
to the support of the campaign when
the microscopes of Dr. Ferrell and his
men began ot produce evidence of what
ailed a good many of the State's people.
Carrying specimens in tin cans, the
people stood in lines to await the at-tention
of the microscopists. The infect-ed
ones got three doses of thymol and
their health was soon restored.
The News and Observer said earlier
skepticism about the hookworm cam-paign
was not justified, and the paper
joined in the effort to publicize the
work.
Among Dr. Ferrell's field directors
was Dr. Benjamin E. Washburn, who
many years later wrote a lively account
of the hookworm campaign in North
Carolina. His booklet was published in
1960 by the Rockefeller Foundation.
Dr. Washburn was one of the most
successful field men in badgering ap-propriations
out of county boards of
commissioners. He travelled the rugged
western end of the State. In the end, he
and his colleagues squeezed money out
of 99 of the 100 county governments.
Only Ashe refused to cooperate.
"However, there were reactionaries,"
Dr. Washburn recalled. "At one place
a member objected because he thought
the money could better be expended in
buying mules for the poorhouse farm.
In another, in the county in which the
State university is located, a member
was shocked at the idea of paying a
doctor to treat worms. He contended
that a certain number of worms was
necessary to aid digestive processes. .
."
Dr. Washburn recalled that while
money was being discussed with the
Alamance County Board of Commis-sioners,
two doctors told of a case
of hookworm they had treated.
Patient's Symptoms
Among the invalid patient's symp-toms
"was eating dirt, paper and chalk,
and he was reported, as a youngster,
to have eaten half of a Bible and an
entire song book." After treatment, the
book eater became a freight train fire-man.
An "unfortunate incident" hampered
the hookworm doctors work in Swain
County. The doctor was giving his lec-ture
at a church meeting before the
preacher arrived. The preacher was de-layed
and sent word for the doctor to
keep on talking. A woman in the aud-ience
dropped dead during the hook-worm
disease lecture.
"It may be that the lecture was too
long," Dr. Washburn conceded.
Some of their findings baffled the
hookworm crews. In Haywood County,
they came upon a situation which surely
would produce a shocking rate of infec-
(Continued on page 9)
THE HEALTH BULLETIN February, 1965
Children Still
Unprotected from
Measles
With the advent of the 1965 measles
season (February through April), Sur-geon
General Luther L. Terry, of the
Public Health Service, Department of
Health, Education, and Welfare, said
recently, "only about 7 million chil-dren
have been protected by measles
vaccines, leaving about 20 million sus-ceptible
children unprotected.
"Measles is so common a childhood
disease that 90 percent of our children
get it before their fifteenth birthday.
Nevertheless, it is not the harmless
illness that most mothers seem to think
it is," Dr. Terry warned.
Although recovery is routine for
most children, about 500 children
every year die from illnesses stemming
from it. These are caused by encephali-tis
or pneumonia. About one out of
every 1,000 cases is followed by en-cephalitis.
Fifteen to 20 percent of the
encephalitis cases are left with such
after-effects as mental retardation, vis-ual
or hearing problems, or behavior
disorders, and about 10 percent of
the encephalitis cases die.
"Over 490,000 cases of measles were
reported to the Public Health Service
in 1964, and we suspect that only about
one-tenth of the actual cases were re-ported,"
Dr. Terry said. Many cases are
not even seen by a physician, he ex-plained,
because so many parents think
of it as an "innocent" disease.
"Fortunately, effective vaccines are
now available and vaccination can re-lieve
the parents of worry about
measles and its after-effects. Only a
single dose is required. In the mean-time,
any child that develops the tell-tale
red splotches should be seen by a
physician at once," Dr. Terry urged.
Water Resources
Curriculum
to be Expanded
An expanded curriculum in Water Re-sources
Development, to be inaugurated
in the Fall of 1965 at the University
of North Carolina, is to be offered
jointly by the Department of Environ-mental
Sciences and Engineering and
the Department of City and Regional
Planning. Engineers would generally
enroll in the department while plan-ners,
economists ond administrators
would enroll in the Department of City
and Regional Planning. In addition, the
resources of the Institute of Goverr-ment
on this campus would be utilized.
Dr. Maynard M. Hufschmidt, currently
Director of Research in the Harvard
University Water Program, will be join-ing
the faculty this summer to head this
curriculum.
Ample funds are available for sup-porting
graduate students in this pro-gram.
If we can provide any additional
information, please do not hesitate to
write to Dr. Daniel A. Okun, Professor
of Sanitary Engineering.
The dates for the North Carolina
ANNUAL WASTE TREATMENT PLANT
OPERATORS SCHOOL will be May 31 to
June 4. The sponsors are: North Caro-lina
Water Pollution Control Associa-tion,
North Carolina State Board of
Health, and the Institute of Government
and the Department of Environmental
Sciences and Engineering of the Uni-versity
of North Carolina at Chapel
Hill. The School will be held in Chapel
Hill. Persons desiring additional infor-mation
may contact Professor George
Barnes, Department of Environmental
Sciences and Engineering, Chapel Hill,
North Carolina 27515.
February, 1965 THE HEALTH BULLETIN
National
Rural Health
Conference
Set for
Miami Beach
Means of providing full-range health
services for the nation's 60,000,000
rural residents will be discussed at the
18th National Conference on Rural
Health March 26-27 in Miami Beach.
Among matters that will be discussed
by farm and medical leaders will be
implementation of programs for financ-ing
hospital and doctor costs among
rural residents.
W. Wyan Washburn, M.D., Boiling
Springs, N. C, chairman of the Ameri-can
Medical Association's Council on
Rural Health, which is sponsoring the
meeting, said the program was de-signed
with four goals in mind:
* To develop ways to utilize com-munity
health resources.
* To improve methods of communi-cation
in health education for rural
people.
* To emphasize the responsibility of
each family in promoting the health and
fitness of its members.
* To more fully understand the in-terdependence
of rural and urban
areas for the improvement of the health
of the people.
The keynote address for the meeting
will deal with "Health is a Way of Life."
and will be delivered by Carl S. Win-ters,
D.D., internationally known lec-turer
from Oak Park, III.
This will be followed by papers on
"Preventive Dental Care," by Joseph
Volker, D.D.S., vice president for health
affairs of the University of Alabama,
and "Safe Use of Agricultural Chemi-cals,"
by Forrest E. Myers, of the Flori-da
Agricultural Extension Service.
A feature of the March 26 afternoon
session will be the panel discussion
on "Practical Implementation of Health
Care Programs." Participants will be
Samuel P. Leinbach, M.D., Belmond,
Iowa, the vice-chairman of the AMA
council; Guithel L. Simpson, M.D.,
Greensville, Ky., chairman of the gov-ernor's
Council on Indigent Medical
Care; John L. Falls, M.D., Red Wing,
Minn.; and John Allen, M.D., Madison,
Wise, director of medical services in
the State Dept. of Public Welfare.
A series of elective discussion groups
will follow. Topics will be "Improving
Family Nutrition," "Communication to
Improve Health Practices," and "Health
of Migrant Workers."
Edward R. Annis, M.D., Miami, past
president of the AMA, will speak at a
banquet that evening.
The March 27 program will open
with a play, "To Temper the Wind,"
which deals with homemaker services.
This will be followed by a paper on
"Medical Quackery," by J. Harvey
Young, Ph.D., professor of history at
Emory University, Atlanta, Ga., and a
symposium, "Developing Community
Health Resources."
Participants will be Dr. Washburn;
Gertrude Humphreys, Morgantown, W.
Va., a state home demonstration lead-er;
Sewall Mil liken, executive director,
Public Health Federation, Cincinnati;
J. Robert Anderson, Richmond, Va., di-rector
of the state's Bureau of Health
Education,- Peter Meek, executive di-rector
of the National Health Council,
New York City; and Eugene G. Peek,
Jr., M.D., Ocala, Fla., president of the
Florida State Board of Health.
The summary speech, "The Challenge
Ahead," will be given by Roy Battles,
director, Clear Channel Broadcasting
Service, Washington, D. C.
8 THE HEALTH BULLETIN February, 1965
Robeson County
4-H #ers
Promote
"Slow Moving
Vehicle"
Signs as
Traffic Safety
Measure
Surveys show that many accidents in-volving
slow moving vehicles are
caused by the lack of adequate identi-fication
and that this often happens
when visibility is poor or at night.
Club members are planning and
working through the cooperation of
Mr. Warren Mathers, safety co-ordinator
with the Robeson County Health Depart-ment.
The purpose, need and value of the
"slow moving vehicle" signs are being
explained to all 4-H Home Demonstra-tion
and other civic clubs in an effort to
create interest and desire among people
of the county to the need to eliminate
some accidents by properly identifying
all slow moving vehicles, thus making
our highways safer.
The 4-H tractor project is being car-ried
by many of the county's farm
youth who are learning proper main-tenance
and operation of farm tractors.
Special emphasis has been placed on
the importance of using these signs.
By providing literature, giving radio
programs, writing news articles and
selling safety tags for slow moving
vehicles, many people of Robeson
County are being made more safety
conscious.
by Selwyn B. Sampson
President of Pembroke's "Eager
Eight" 4-H Club
Mr. R. H. Livermore, President of
Pates Supply Company in Pembroke,
helps 4-H'ers start their campaign by
buying signs to go on company trac-tors
and other slow moving vehicles.
The triangular signs, with bright red
center outlined in deeper red, show up
equally well during night or day. They
are designed for farm, highway and
other vehicles that travel 25 miles per
hour or less on highways.
HOOKWORM CAMPAIGN
(Continued from page 6)
tion. A survey showed the county had
few sanitary privies. Open-type privies
were placed over the many streams
and springs. The springs were the
source of drinking water in many
places.
Of the county's 15,436 population
in 1910, 3,119 persons were exam-ined
and only 200 were found to be
infected with hookworm.
The doctors didn't say so, but this
seemed to be a high tribute to the rare
qualities of Haywood's mountain air.
February, 1965 THE HEALTH BULLETIN
The Dental Care
Program of Rowan County
A Dental Care Program for the Med-ically
indigent, long felt as a need by
the Rowan County Health Department,
is now a reality as a result of the sum
of $10,500 bequeathed to the local
health agency in the will of the late
Judge R. Lee Wright of Salisbury.
Indeed, a dream has been fulfilled
as well as a need. For with the original
construction of the Health Center in
1953, a room for a dental clinic was
included, which provided such basic
essentials as water supply and sinks.
However, for want of funds for dental
equipment, the room has been used
during the intervening years as extra
office space. Now it boasts the finest
of equipment.
"For use of the aged and infirm"
were the terms of Judge Wright's will
in designating his gift to the Health
Department. As an appropriate use, the
dental care program was selected
jointly by Mrs. Sam Edwards, his niece,
George R. Uzzell, trustee of his estate,
and by the County Board of Commis-sioners.
The general objectives of the pro-gram
are to relieve pain, to promote
health, and to provide dentures for the
medically indigent.
Specifically, and by established pol-icy,
the persons being served are the
medically indigent residents of Rowan
County of over age 65 who are not
reached by other currently operating
programs, such as the Kerr-Mills Bill.
Under the latter's provisions, the Wel-fare
Department can pay only for fill-ings,
extractions, and denture repairs
(for the medically indigent of over 65).
Particular attention is being concen-trated
for the time being on that seg-ment
of the eligible group who reside
in any nursing, boarding, or rest home
financed by Rowan County taxes. To
date, all patients served have come
from the boarding homes.
The dental care is entirely free to
the eligible. Incidental expenses are
being met by the Chronic Disease Sec-tion
of the North Carolina State Board
of Health. No Rowan County funds
are being used directly in the program.
The Rowan County Dental Society
has actively supported the program and
assisted with the selection of equip-ment.
In addition they will continue as
the source of the personnel to provide
the service. At present Dr. Bruce A.
Ketner attends the patients.
The clinic is in operation one half
day a week, the current time being
Wednesday mornings.
In expressing his gratitude for this
addition to the Health Department's
services, Dr. Moffitt K. Holler, Director,
commented that, to his knowledge,
this is the only dental program of its
kind in North Carolina. Also he ob-served
that the Rowan County agency
is the only Health Department in the
State to have received a bequest of
money for a Health Department func-tion.
"We are indeed appreciative of
Judge Wright's kindness and generos-ity,"
said Dr. Holler. "And we feel that
this program will be a fitting and last-ing
tribute to a fine gentleman, who
was not only a leader in the civic,
(Continued on page 12)
(See Picture on Opposite Page)
FREE DENTAL CLINIC-The aged and in-firm
of Salisbury-Rowan are being af-forded
free dental service through the
cooperation of the State Board of
Health and funds left to the county by
the late Judge R. Lee Wright. Dr. Bruce
Ketner, currently conducting the week-ly
clinic, is shown with Mrs. Ben Bla-lock,
a patient at a local rest home.—
(Post Staff Photo by Barringer).
10 THE HEALTH BULLETIN February, 1965
February, 1965 THE HEALTH BULLETIN 11
DENTAL HEALTH
(Continued from page 10)
church, and professional activities of
Salisbury, but who also rendered dis-tinguished
service to the entire County
during his years in the North Carolina
General Assembly and Senate and as
Superior Court Judge of North Caro-lina."
Futilely, for some eleven years, the
door of the clinic has borne the label
"Dentist." Now at its entrance is a
beautiful bronze tablet with the in-scription:
This Room Equipped
in Memory of
Judge R. Lee Wright
and Wife
Sally Oakes Wright
The tablet was composed and placed
in accordance with the suggestions
of Mrs. Edwards, who had made her
home with Judge and Mrs. Wright ever
since the death of her own parents
when she was four years old.
Poliomyelitis
Vaccine Success
Demonstrated
The success of the poliomyelitis vac-cines
is clearly demonstrated by three
facts published recently by the Com-municable
Disease Center.
(1) Only 94 cases of paralytic polio-myelitis
occurred in this country dur-ing
1964; this number is less than one
fourth the number of paralytic cases
reported during 1963, which was the
previous record low year.
(2) No seasonal pattern of increased
incidence was noted during 1964.
(3) There were no outbreaks of hu-man
poliomyelitis reported anywhere
in the United States during 1964.
International Health
Meeting In Madrid
With the impulsive pressures of pop-ulation
growing every day in every
part of the world, how can people con-cerned
with health and health education
effectively contribute to immediate and
long-range action? This is one of the
central questions being asked by lead-ers
of the International Union for Health
Education as they met in Paris recently
to complete planning for the 6th Inter-national
Conference on Health and
Health Education, to be held in Madrid,
Spain, July 10-17, 1965.
The theme of this world conference
is "The health of the community and
the dynamics of development." It com-bines
concern with the various aspects
of economic and social development
with health and health education con-siderations.
Also, it gives special at-tention
to population problems and the
migration into the urban cities— an "im-plosive"
pressure in engineering terms.
A large group from the United States
is expected to participate in the Madrid
meetings, which will include technical
study groups and tours of health and
educational facilities as well as the us-ual
plenary and related meetings. The
program, reflecting the growing aware-ness
everywhere of the importance of
health as a primary factor in national
growth, is characterized by originality
and variety. It will combine the scien-tific
with the practical in its approach
to the problem of how best to create
solid bases for effective action to en-sure
better health around the globe for
all.
Write to the Editor of the Health
Bulletin if you are interested in going.
12 THE HEALTH BULLETIN February, 1965
Flim Flam Artists
Are At Work
Two flim-flam artists were at work
in Haywood County trying to conjure
money out of households through a
health ruse. According to Sheriff Jack
Arrington, who issued the warning,
the gimmick works like this:
Two white men—one about 45 and
the other about 60—knock on a per-son's
door and tell the householder
that they are from the Haywood Coun-ty
Health Department.
The artists quickly explain that a
new state law has been passed that
requires each house to be sprayed in-side
for tuberculosis germs.
While one man is in the house spray-ing
the rooms, the other man is outside
cutting the telephone wires if there are
any.
This gimmick has already worked
in the White Oak Community, according
to the sheriff.
He said an elderly man paid the
pair $140.00 to spray his house.
The sheriff's department learned
about the incident after the man's son
came home and found out what had
happened.
So the sheriff has asked all persons
to be on the look-out for the pair and
should they show up, the sheriff would
like for the owner to get as much in-formation
as possible— like color of
their car, license number, description
and such— and then refuse the service.
After refusing the service, the sheriff
said call his department or the nearest
police department.
He warned that the flim-flam artists
are "slick" enough to get by with
talking some people into a spraying
job.
People ought to only do business
with people they know and then they
would be safe," he added.
Short Course In
Accident Control
The third annual short course in Pro-gram
Development in Public Health
Accident Control has been announced
by the Department of Public Health
Administration of the University of
North Carolina School of Public Health.
The course will be held at the School
of Public Health in Chapel Hill, May 30
through June 4, 1965.
The course has been designed for:
• Administrators of state, city, or
county health departments.
• Directors, supervisors, or consul-tants
in nursing, sanitation, edu-cation,
and other allied programs
in state, city, and county health
departments.
• Accident control workers in health
departments.
Course content will include:
• Lectures on etiology, fact-finding,
and program planning.
• Problem-solving by small multi-disciplinary
groups.
For further information, write to the
Department of Administration, School of
Public Health, University of North Caro-lina
at Chapel Hill, or the Accident Pre-vention
Section, North Carolina State
Board of Health, Raleigh, North Caro-lina.
Herbert Shore, President of the Amer-ican
Association of Homes for the Aging,
has announced that AAHA's Fourth An-nual
Meeting and Conference on "The
Social Components of- Care" will be
held from Nov. 1-4, 1965 at the Disney-land
Hotel, Anaheim, California.
Highlights of the meeting will in-clude
the presentation of the annual
AAHA Award of Honor and a Legisla-tive
Breakfast Meeting on "The Aged
in The Great Society".
February, 1965 THE HEALTH BULLETIN 13
UNC Professor
Loaned to the Philippines
The World Health Organization
(WHO) has selected a University of
North Carolina professor as the public
health nursing consultant for a National
Seminar in Public Health Administration
in the Philippines in February.
Dr. Margaret L. Shetland, director of
the Public Health Nursing Teacher Prep-aration
Program at the UNC School of
Public Health and UNC School of Nurs-ing,
left in early January for her two-months
assignment.
She will be one of three consultants
for the seminar in Baguio, the sum-mer
capital of the Philippines. She will
serve with Dr. F. Main of Northern
Ireland and Dr. A. Yerby of New York
City.
Dr. Shetland was chief nursing con-sultant
with the U. S. Overseas Mission
and visiting professor of public health
nursing at the University of the Philip-pines
in Manila from late 1956 to early
1959. This will be her first visit to the
area since 1959.
The seminar in Baguio will be limited
to provincial health officers in the Phil-ippines,
equivalent to state health offi-cers
in the U. S.
The seminar staff will devote a
month to field visits and program
preparation.
Seventh Recreational Institute
The University of North Carolina,
through its Recreation Curriculum, an-nounces
that the Seventh Southern Reg-ional
Institute on Recreation with the
III and Disabled will be held in Chapel
Hill, North Carolina on April 22, 23,
and 24, 1965.
The Steering Committee for this In-stitute
met in Chapel Hill recently and
formulated a very interesting, practical
and progressive program. Detailed in-formation
regarding the Institute was
sent out in January.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
Lenox D. Baker, M.D., President Durham
John R. Bender, M.D., Vice-President Winston-Salem
Ben W. Dawsey, D.V.M Gastonia
Glenn L. Hooper, D.D.S. Dunn
Oscar S. Goodwin, M.D. Apex
D. T. Redfearn, B.S. Wadesboro
James S. Raper, M.D. Asheville
Samuel G. Koonce, Ph.G. Chadbourn
John S. Rhodes, M.D. Raleigh
EXECUTIVE STAFF
J. W. R. Norton, M.D., M.P.H. State Health Director
Jacob Koomen, Jr., M.D., M.P.H. Assistant State Health Director
J. M. Jarrett, B.S. Director, Sanitary Engineering Divisioyi
Martin P. Hines, D.V.M. , M.P.H. Director, Epidemiology Division
W. Burns Jones, M.D., M.P.H. Director, Local Health Division
E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division
Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division
Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division
James F. Donnelly, M.D. Director, Personal Health Division
14 THE HEALTH BULLETIN February, 1965
Southern
Branch, APHA
To Meet
In New Orleans
"Health Support in Man's Changing
Environment," is the theme of the 33rd
annual meeting of the Southern Branch,
American Public Health Association, to
be held in New Orleans, La., April 7, 8,
9.
Keynote speaker at the first general
session will be Dwight F. AAetzler, C.E.,
M.S., president of the American Public
Health Association. Miss Elizabeth S. Hol-ley,
president of Southern Branch, will
preside at the Wednesday and Friday
sessions.
Speaking Thursday will be Dr. Paul
Q. Peterson, Assistant Surgeon General,
Department of Health, Education and
Welfare, who will discuss "Social and
Physical Environment." Dr. Leroy E. Bur-ney,
Vice President for Health Sciences,
Temple University, will talk on "The
Professional Environment: Scientific
Knowledge, Technical Application and
Fiscal Support." The third speaker will
be Dr. Robert E. Coker, professor of
Dr. Murray Grant of Washington, D.
C. visited North Carolina early in Feb-ruary
speaking to a Seminar at the
School of Public Health in Chapel Hill.
He also spoke to the staff of the State
Board of Health and is shown in the
picture with Dr. J. W. R. Norton, State
Health Director. Dr. Grant is Health Di-rector
of the District of Columbia which
includes hospitals as well as other pub-lic
health services in a budget of some
$50 million.
public health administration, University
of North Carolina School of Public
Health. His topic is "Organization for
Support of Health." Dr. Russell E. Tea-gue,
state commissioner of health, Com-monwealth
of Kentucky, will preside
Tuesday.
Summarizing the program at the
branch meeting April 9 will be Dr.
Malcolm U. Dantzler, director for the
Charleston, S. C, county health depart-ment.
Program chairmen are Charles G. Jor-dan,
engineering division, Dade County
health department, Miami, Fla., and Dr.
Robert F. Lewis, professor and head,
division of biostatistics, Department of
Tropical Medicine and Public Health,
Tulane University, New Orleans, La.
Hosting the Southern Branch meeting
will be the Louisiana Public Health As-sociation,
Inc., Miss Edna Irl Mewhin-ney,
president.
Local arrangements committee chair-men
announced prizes for pre-registra-tion
at the Jung Hotel, convention head-quarters,
and plans for a shrimp boil,
6:30 p.m., Tuesday, April 6. In addi-tion,
there will be Dixieland bands,
sight-seeing tours, and other attractions
to be found only in America's famed
Mardi Gras city.
February, 1965 THE HEALTH BULLETIN 15
THE HEALTH BULLETIN
P. O. Box 2091
Raleigh, N. C. 27602
LIBRARIAN trbaR?
DIVISION OF HEALTH AFFAIR LIBRARY
N.C. U£%* HOSP.
CHAPEL HILL, N.C
U. N. C.
If you do NOT wish to con-tinue
receiving The Health Bul-letin,
please check here |
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and return this page to '
—
the address above. Primed by The Graphic Press, Inc., Raleigh, N. C.
DATES AND EVENTS
March 21-24 — N. C. Association of
Nursing Homes, Velvet Cloak Inn,
Raleigh.
March 22-26 — American College of
Physicians, Chicago, III.
March 26-27 — National Conference on
Rural Health, Miami Beach, Fla.
April 2-3 — Annual Meeting, N. C.
Physical Therapy Association, Win-ston-
Salem.
April 4-9 — American Industrial Health
Conference, Bal Harbour, Maine.
April 5-9 — Southern Branch, APHA,
Jung Hotel, New Orleans, La.
April 7-9 — National Council on Alco-holism,
Tulsa, Okla.
April 9-15 — American Academy of
General Practice, San Francisco, Cal.
April 12-15 — American Society for
Public Administration, Kansas City,
Mo.
April 20-22 - Eastern Branch, NCPHA,
Blockade Runner Hotel, Wrightsville
Beach.
April 22-23 — Annual Meeting, N. C.
Tuberculosis Association, Robert E.
Lee Hotel, Winston-Salem.
April 22-24 - Seventh Southern Re-gional
Institute on Recreation with
the III and Disabled, Chapel Hill.
April 23-24 - Anual Meeting, N. C.
Chapter of the American College of
Surgeons, Blockade Runner Hotel,
Wrightsville Beach.
Charlotte's Occupational Health Con-ference,
originally scheduled for March,
has been postponed and tentatively set
for October 7.
CONTENTS
John Atkinson Ferrell 1, 2, 3
Hookworms Once Plagued
Tar Heels 5
Children Still Unprotected
from Measles 7
Water Resources Curriculum
to be Expanded 7
National Rural Health Conference
Set for Miami Beach 8
Robeson County 4-H'ers
Promote Safety 9
The Dental Care Program of
Rowan County 10, 11
International Health Meeting
in Madrid 12
Poliomyelitis Vaccine Success
Demonstrated 12
Flim Flam Artists Are at Work 13
Short Course in Accident Control 13
UNC Professor Loaned to
Philippines 14
Southern Branch APHA Will Hold
Annual Meeting in New Orleans 15
16 THE HEALTH BULLETIN February, 1965
Eldercare L
APR 29 1965
Versus
DIVISION OF
Medicare H£ALTH AFFAIRS L,BRARY
Some Comments and
Comparisons
See page 2 and following
Medicare Awaits Senate Action
THE Medical Care of the Aged bill Congress is preparing for passage has a
long, curious history.
Hospitalization-nursing home portions first were proposed about fifteen
years ago. The idea had support from President Truman but failed to materialize.
Since then, the social security-financed plan consistently has been opposed by
the American Medical Association and other professional and business groups.
Until this session the bill never has been voted out of the House Ways and Means
Committee. Thus, the House never has had an opportunity to act on it. The
bill has now passed the House and is headed for several weeks debate in the
Senate.
This year, however, the climate has changed dramatically. The AMA, even in
the face of almost certain defeat, waged its strongest campaign against the ad-ministration's
Medicare bill. And the AMA pushed its own answer to health
care for the aged—Eldercare—maintaining that it offered far greater benefits than
did Medicare. This was disputed by Rep. A. Sydney Herlong, Jr., (D., Fla.), co-sponsor
of the Eldercare bill, who called AMA advertising "Misleading." For the
AMA to give the impression the bill provides complete coverage is not so, he
said. "It just makes it available for the states to provide it if they want to."
AMA's hard-hitting drive succeeded in part and perhaps not as the association
intended. The campaign has succeeded, not in building opposition to Medicare
as such, but in alerting the public to the fact that Medicare's benefits would be
limited. Most letter writers to the House committee members said Medicare would
not be enough.
Democrats on the House Ways and Means Committee realized that Medicare
alone would be a disappointment to many elderly persons.
The committee decided to work out a comprehensive medical care bill for the
aged to include payments for most drugs, medical devices, and physicians' fees.
There would be some charge to prevent overuse of benefits, and an attempt
would be made to work out a system for regaining part of the cost from wealthy
elderly persons. The system would be voluntary.
So the AMA successfully focused public attention on Medicare's deficiencies
but did not succeed in stopping the bill.
THE HEALTH BULLETIN March, 1965
How the AMA-Supported Eldercare Bill
Compares with the Administration
Sponsored Medicare Proposal
Reprinted with permission from material prepared for publication in Modern
Medicine, Copyright 1965 by Modern Medicine Publications, Inc.
ELIGIBILITY
Eldercare Bill Administration Bill
Needy persons 65 and older. Partial All persons 65 and older, regardless of
or total underwriting of health care in- need. About 16% million eligible un-surance
determined by need limits set der social security or railroad retire-by
states. AAAA estimates 11,800,000 ment plans; about 2 million others to
are eligible depending on need, not be covered through general tax funds,
counting persons covered by such pro-grams
as Old Age Assistance (OAA)
and Federal Employees Health Benefit
Plan.
CONTROL
Eldercare Bill Administration Bill
By state welfare or health agencies By Department of Health, Education,
through existing Kerr-Mills channels and Welfare through existing social se-after
acceptance by state legislature. curity channels, allocations to be kept in
separate Treasury trust fund.
COST
Eldercare Bill Administration Bill
Undetermined. One AAAA estimate of Estimated at $2 to $2.4 billion yearly,
nearly $2 ]/2 billion yearly is based on
$250 premium per person per year.
Another AAAA estimate is "between $2
and $4 billion."
March, 1965 THE HEALTH BULLETIN
FINANCING
Eldercare Bill
Through state and federal funds. Per-centage
of federal funds—52.5 to 84%
—based on a state's per capita income,
with lower income states getting a
higher proportion. Funds are used by
welfare or health departments to buy
health insurance under guaranteed re-newable
private plans. Income levels to
qualify for assistance would be deter-mined
by states, with the maximum at
least as high as the highest level now
required in the state under Kerr-Mills—
presently ranging from $1,080 to
$3,000 for individuals; $1,560 to
$3,900 for couples. Persons above
maximum would be ineligible for aid
but could purchase the same noncan-celable
policies. Those between maxi-mum
and minimum would pay part of
their premium on a sliding scale. Those
below minimum would pay nothing.
Administration Bill
Through increased social security con-tributions.
Total social security payroll
deductions, including the portion for
health care, from 1971 on, would be
10.4% (5.2% from employee; 5.2%
from employer) or 7.8% for self-em-ployed,
deductions to be made on the
first $5,600 of salary rather than the
current $4,800. Payments are made to
hospitals or other service providers or
to Blue Cross-type organizations repre-senting
hospitals. Yearly outlay of some
$250 million is anticipated from gen-eral
tax funds for those not covered by
social security or railroad retirement.
The Health Bulletin
First Published—April 1886
The official publication of the North Carolina
State Board of Health, 608 Cooper Memorial Health
Building, 225 North McDowell Street, Raleigh, N. C.
Published monthly. Second Class Postage paid at
Raleigh, N. C. Sent free upon request.
EDITORIAL BOARD
Charles M. Cameron, Jr., M.D., M.P.H.
Chapel Hill
John T. Hughes, D.D.S., M.P.H.
John C. Lumsden. B.C.H.E.
Mary Ann Farthing, M.S.
Jacob Koomen, Jr., M.D., M.P.H.
Bryan Reep, M.S.
John Andrews, B.S.
Glenn A. Flinchum, B.S.
H. W. Stevens, M.D., M.P.H., Asheville
Editor—Edwin S. Preston, M.A., LL.D.
Vol. 80 March, 1965 No. 3
THE HEALTH BULLETIN March, 1965
BENEFITS
It is impossible to compare benefits of the two bills since specific Eldercare
coverage depends on each state. However, the Herlong-Curtis bill is a modifica-tion
of the Kerr-Mills mechanism, so present Kerr-Mills practices are of interest,
even though no state is committed to follow these practices as a basis for partici-pation
under Herlong-Curtis. Presently, 40 states, 3 territories, and the District
of Columbia have operating Medical Assistance for the Aged (MAA) plans under
Kerr-Mills. According to iatest AMA figures (April 1964), 176,000 persons were
receiving assistance.
HOSPITALIZATION BENEFITS
Eldercare Bill Administration Bill
Dependent on extent of insurance pur- Sixty days per benefit period. Patient
chased by federal-state funds. pays a deductible equal to the cost of
one day national average hospital care.
Recipient is entitled to this every 180
days if there is an interval of 90 days
without hospitalization.
Kerr-Mills Experience. Of 44 states and territories offering hospitalization under
existing Kerr-Mills program (AMA report, Dec. 23, 1964), duration of paid hos-pitalization
varies from ten days per year (followed by review committee ap-proval
for possible extension) to no fixed limit. Nineteen states have no fixed
limit but leave determination of duration to the administering agency. In 15 states
with a fixed limit and no review mechanism, duration varies from twelve to
seventy days per year. Nine states have a fixed limit with reviewal for possible
extension. Benefits in one state recently starting the program are unreported.
NURSING HOME BENEFITS
Eldercare Bill Administration Bill
Dependent on extent of insurance pur- Sixty days per benefit period, no de-chased
by federal-state funds. ductible. Recipients must be transferred
from hospital to affiliated home or to
one approved by HEW.
Kerr-Mills Experience. Of 30 states and territories offering nursing home care
under existing Kerr-Mills program (AMA report, Dec. 23, 1964), duration of paid
care ranges from twenty-six days per year to no fixed limit. Eighteen states have
no fixed limit and leave determination of duration to the administering agency.
Twelve limit the stay to twenty-six to one hundred eighty days per year. Only
five states and territories require such care to be immediately preceded by hos-pitalization.
March, 1965 THE HEALTH BULLETIN 5
PHYSICIAN SERVICE BENEFITS
Eldercare Bill Administration Bill
Dependent on extent of insurance pur- None. Private insurance carriers invited
chased by federal-state funds. to provide such insurance without dan-ger
of antitrust involvement.
Kerr-Mills Experience. Of 39 states and territories offering physician payment
under existing Kerr-Mil Is program (AAAA report, Dec. 23, 1964), all have limi-tations.
Some limit the number of calls per month or quarter, some have a ceiling
on payment, and others limit the number of visits per hospitalization. Only 6 states
limit physician payment to certain conditions, such as acute, chronic, or long-term
illness. Four states do not pay physician fees under AAAA mechanism but care
for such patients without charge as staff patients.
DRUG BENEFITS
Eldercare Bill Administration Bill
Dependent on extent of insurance pur- Covers cost of drugs customarily fur-chased
by federal-state funds. nished when patients are in hospitals
or nursing homes. No coverage outside
these facilities.
Kerr-Mills Experience. Of 32 states and territories offering drug coverage under
existing Kerr-Mills program (AAAA report, Dec. 23, 1964), most are determined
by the administering agency. Four states have a cost limit: $120 a year, $150 a
year, $15 a month, $10 a prescription.
DENTAL CARE BENEFITS
Eldercare Bill Administration Bill
Dependent on extent of insurance pur- None,
chased by federal-state funds.
Kerr-Mills Experience. Of 26 states and territories offering dental care under
existing Kerr-AAills program (AAAA report, Dec. 23, 1964), 14 are restricted to cer-tain
dental conditions. One state has a $100 limit. Another limits care to patients
in hospitals or nursing homes. The rest leave determination of benefits to the
administering agency.
6 THE HEALTH BULLETIN March, 1965
OTHER BENEFITS
Eldercare Bill Administration Bill
Dependent on extent of insurance pur- Up to 240 nonphysician home health
chased by federal-state funds. care service calls per year. Diagnostic
outpatient services with deductible in
any one month of an amount equal to
half the average nationwide cost of one
day's hospital care. Services of radiol-ogists,
pathologists, physiatrists, and
anesthesiologists are included as hos-pital
services.
Kerr-Mills Experience. Under existing Kerr-Mills program (AMA report, Dec. 23,
1964), such services as home nursing, outpatient laboratory work, or diagnostic
X-ray are offered by 33 states.
Medicare Vs. Eldercare
as viewed by Consumer Reports
AFTER two decades of effort, 1965 appears to be the year for Medicare—
a Federally-administered national hospital insurance plan, financed through
Social Security contributions for persons over 65. This time the administra-tion's
Medicare bill seems assured of passage. As usual, though, the American
Medical Association has proposed a last-gasp substitute. A comparion of the two
proposals is instructive.
The Medicare bill may of course be altered in the legislative process, but its
four basic provisions are not likely to be changed significantly. They can be out-lined
briefly. For those over 65, Medicare would:
• Pay the full costs of up to 60 days of hospitalization (in ward or semi-private
accommodations), minus a first-day deductible, for each benefit period (which
begins on the first day of hospitalization and ends whenever the patient has ac-cumulated
90 days out of the hospital within a period of 180 days).
• Provide for an additional 60 days of post-hospital care for each illness in a
convalescent or rehabilitation center operating under an agreement with a hos-pital
(not an ordinary, custodial-care nursing home).
• Pay for up to 240 home nursing visits a year under medical supervision, in
programs organized by nonprofit voluntary or public agencies.
• Provide payment for hospital outpatient diagnostic services and tests, minus a
deductible that would exclude routine low-cost laboratory or other diagnostic
procedures.
March, 1965 THE HEALTH BULLETIN
These provisions would be financed by an increase in the Social Security with-holding
tax. Ultimately, a citizen would contribute (to a special, separate health
care trust fund within the Social Security system) 0.45% of his earnings up to
$5600, and his employer would contribute an equal amount. Special provision
would be made for those now over 65 who are not covered by Social Security
through the Government's general fund.
The Medicare program gives the citizen free choice of physician and hospi-tal.
It does not pay the costs of doctor bills, out-of-hospital drugs, prolonged or
catrastrophic illness requiring long, continuous hospitalization, or extended custo-dial
care in nursing homes.
CU's medical consultants believe that this is, by and large, a sound basic
package. The 60-day provision would encompass all but about 5% of the usual
hospital stays of older persons, and the extended-care proposal would both re-lieve
the pressure on general hospital beds and spur the construction of badly-needed
convalescent and rehabilitation facilities in many communities. Services
of this kind are essential in many illnesses following their acute stage and prior
to the time a patient can return to his home or transfer (if necessary) to a custodial
institution.
The provision for organized home nursing services has obvious value: such
services often preclude the need for hospitalization and permit earlier discharge
from hospital or convalescent center. Out-patient diagnostic services also are
capable of averting many costly hospitalizations by encouraging the early de-tection
and treatment of disease—at a time when it may be cured or controlled
by relatively simple short-term procedures.
Since the heaviest health cost of the elderly is hospitalization, the Medicare
coverage could make it financially possible for the first time for many citizens to
purchase voluntary insurance (of the Blue Shield type) to cover physicians' bills
and other supplementary costs.
The AMA substitute for Medicare at first glance seems invitingly compre-hensive.
(It is, in fact, a resurrection of proposals made during the Eisenhower
administration that the AMA bitterly opposed at the time, and again just a few
months ago at its House of Delegates meeting. The AMA now refers to its "new"
proposal as a "redefinition" of policy.) The AMA substitute simply proposes the
use of state and Federal funds to buy Blue Cross-Blue Shield or commercial health
insurance for indigent persons over 65—it does not say how the funds would
be raised, in the absence of a Social Security tax.
The proposal does say, however, that a means test would be required to
determine the eligible poor, with the states using state and Federal money to
pay all, some, or none of the insurance premium cost, depending on the citizen's
qualification under the means test. Means tests are—moral considerations aside—
enormously expensive and difficult to administer. Furthermore, the program
would be administered by the states, raising the possibility that there would
be 50 different kinds of governmental machinery, eligibility standards, and pay-ment
procedures. (Under some state rules setting eligibility for help under the
current Kerr-Mills law, ownership of property or even ability of one's children to
pay can make an old person ineligible.)
The subsidized insurance would pay for physicians' and surgeons' bills and
drug costs as well as hospital bills, and an AMA statement asserts that this would
be "comprehensive health care" and not "limited to hospital and nursing home
8 THE HEALTH BULLETIN March, 1965
care representing only a fraction of the cost of sickness." As CU has pointed out,
however, this "fraction" covers the heaviest, the most financially crippling share
of the burden. Furthermore, since the AMA has not spelled out specifically what
the private insurance would cover (and in existing voluntary insurance policies,
cash benefits, days of coverage, and other provisions vary widely from plan to
plan and from area to area), it is difficult to tell how "comprehensive" the pro-tection
of the AMA's proposal would be.
The current Medicare proposal, obviously, will not solve every aspect of the
nation's health problems, even for those over 65. It does not and cannot guaran-tee
good medical care to its beneficiaries, and it pays relatively little attention to
the quality of the services it pays for (though the bill does contain a provision
for periodic review, by the medical staffs of participating hospitals, of the neces-sity
for hospitalization, length of stay, and other such features). However, it is a
significant beginning.
Reprinted with permission from Consumer Reports (March, 1965). Copyright 1965
by Consumers Union of U. S., Inc.
Determining Medical Indigency
Reprinted by permission from the American Journal of Public Health,
copyright 1964 and 1965 by the American Public Health Association
BASIC in the provisions of Eldercare, sponsored by the American Medical
Association, is the principle that the health care shall be made available
only to persons qualifying as being medically indigent. Determination of
medical indigency is admittedly a difficult and costly process.
The National Council on Aging presented a report on this subject at the 1964
meeting of the National Conference on Social Welfare. The report, entitled, "Prin-ciples
and Criteria for Determining Medical Indigency", was published in full in
the October, 1964 issue of the American Journal of Public Health.
The principles set forth in this report of the National Council on Aging are
reprinted here on the following pages through the courtesy of the American Jour-nal
of Public Health, together with the comments of Milton I. Roemer, M.D., Pro-fessor
of Public Health at the University of California, School of Public Health,
in Los Angeles. Dr. Roemer was invited by the National Council on Aging to be
one of the two discussants of this report at the National Council on Social Welfare
and his comments carried in the March, 1965, issue of that publication.
March, 1965 THE HEALTH BULLETIN 9
These principles are goals that will
not be attained quickly; in many in-stances
they call for changes in legisla-tion
and policies and for training of
personnel. Some changes could be
made by revising administrative pro-cedure
and regulations. Others will de-pend
upon the public's conviction of
the need to expend the necessary
funds.
The committee believes that carrying
out the recommended principles will re-sult
in conservation of human resources
and in prevention of suffering now
caused when handicapping policies and
unsound practices obtain in the de-termination
of medical indigency.
Principles for the Determination of
Medical Indigency
1. People who cannot afford medical
care are entitled to it as a human right
and as a sensible means of conserving
human resources.
2. Neither race, creed, color, country
of national origin, citizenship, nor
length of residence should be criteria
for determining medical indigency.
Mental retardation, advanced age, or
previous history of mental illness should
not of themselves prejudice financial
eligibility for needed medical care.
3. Determination of the amount and
kind of medical care needed is a judg-ment
of the health professions. The de-cision
as to eligibility for aid in meet-ing
this need should be a combined
medical and social judgment, with due
consideration given to implications of
the illness or handicap for the family,
estimated cost of care, relationship of
the medical need to the patient's re-sources,
medical or health needs of
other members of the family, and spe-cial
family needs.
4. Persons and families having in-comes
and resources at or below speci-fied
levels should be eligible for pay-ment
for medical care automatically.
Only for persons and families with in-comes
above the specified levels need
further inquiry be made.
5. Criteria applied in determining
financial eligibility should be objective-ly
established and should not result in
family insolvency.
6. Income levels for use in the de-termination
of medical indigency should
represent a reasonable level of living.
7. In order to provide for his med-ical
care, no claim or lien should be
taken on a patient's home and furnish-ings
or on equipment essential for earn-ing
a living.
8. No arbitrary income ceiling should
be set beyond which no patient can be
judged medically indigent.
9. Legal or administrative policies
specifying that relatives assume finan-cial
responsibility are undesirable, ex-cept
in case of the patient's spouse or
the parents of a dependent child.
10. Community health and welfare
agencies that provide or subsidize med-ical
and dental care should collaborate
in developing general policies as a
framework within which each deter-mines
medical indigency.
11. When several agencies are deal-ing
with a patient who can partially
pay for his medical care there should
be joint agreement on the respective
responsibilities and shares in the total
patient funds available.
12. The agency that provides the sub-sidy
for medical care should determine
medical indigency.
13. General policies should be ad-ministered
flexibly in relation to indi-vidual
circumstances and problems.
14. Qualifying conditions of eligibil-ity
should conform to social values of
dignity, privacy, confidentiality, indi-vidual
responsibility, and family unity.
These should be taken into account both
in regulations established and in proc-essing
applications.
10 THE HEALTH BULLETIN March, 1965
15. A public agency or institution
rendering or subsidizing medical care
has the obligation to consider an ap-plication
from any person within the
group it serves and to take action on an
appeal of the decision.
These principles are fundamental to
good administration of the determina-tion
of medical indigency. Extraordi-nary
situations may sometimes arise
when one of the principles of a more
practical nature will need flexible ad-ministration
on an individual basis.
Present-day experience indicates that
such situations rarely occur.
Dr. Roemer's Letter to
the Editor of the
American Journal of
Public Health
To the Editor:
The report of the National Council on
Aging entitled "Principles and Criteria
for Determining Medical Indigency"
and published in the October, 1964,
issue of the Journal calls for comment.
This important document was given
its first public presentation at the Na-tional
Conference on Social Welfare, as-sembled
in Los Angeles on May 26,
1964. It happens that I was invited by
the National Council on Aging to be
one of the two discussants of the report,
as it was presented by Mrs. Edith Alt.
My remarks and those of the other dis-cussant
(Mr. Carel Mulder of the Cali-fornia
State Department of Social Wel-fare),
however, have not been publish-ed.
There are some very serious social
policy implications to a formal crystal-lization
of the whole concept of "med-ical
indigency" that may be overlooked,
while—with the best of intentions—one
is trying to improve medical care for
the poor. The fundamental question is
"how should medical care for the poor
be financed?" rather than "how should
medical indigency be determined?" I
tried to explore these conceptual prob-lems
in my commentary on the report,
which was as follows:
There can be no doubt that this report
on principles for determining medical
indigency, produced by the National
Council on the Aging and summarized
so very well by Mrs. Alt, is a positive
contribution to the tasks of administra-tion
of medical care in the United States
today. A variety of governmental and
voluntary programs must now make
such determinations, and effectuation of
the principles advocated in this report
would surely facilitate proper medical
care and protect human dignity more
than has often been the reality in the
past. The principles proposed on key
issues like property liens, residency re-quirements,
relative's responsibility,
court commitments, and so forth, would
move us significantly further along the
path from tribalism to social responsi-bility.
Nevertheless, as I read through this
fine report—exemplary in its careful
workmanship and presentation— I be-came
more and more unhappy about it.
My disturbance was not for what it
said, but for what it did not say. I am
aware that the distinguished committee,
representing as it did organizations of
diverse sociopolitical philosophies, set
itself a specific task, to define "criteria
of medical indigency," from which it
deliberately did not deviate. Yet it is
the very posing of this task that I
would like to comment on.
Perhaps, as the "Foreword" of the
report states, the project was 25 years
March, 1965 THE HEALTH BULLETIN 11
overdue, but why was it undertaken
just now? Surely it is not unrelated to
the fact that in 1960 we acquired in the
United States the first federal public
assistance legislation in which the con-cept
of "medical indigency" has been
embodied as a statutory basis for aid.
This emerged from a national debate
on health insurance for all of the aged.
Crippled children's programs, Veterans
Administration medical services, and
certain other programs, it is true, pro-vide
federal funds for specific bene-ficiaries
who are, in fact, "medically in-digent,"
and purely local or state funds
have long been used for the "med-ically
indigent" under the "general as-sistance"
heading. But the Kerr-Mil Is
program on Medical Assistance to the
Aged was the first amendment to the
basic structure of welfare services for
the needy in which federal support for
this concept became crystallized into
law.
The MAA amendments, of course, ap-ply
only to persons past 65 years of
age, but it is perfectly clear that certain
groups would like to see the concept
extended to all age levels, and indeed
the NCOA Report specifically empha-sizes
this wider applicability. The basic
premise, therefore, is that the total pop-ulation
may, for the purpose of financ-ing
medical care, be divided into sev-eral
more or less distinct classes. Based
on the recommendations in the report,
these would be essentially as follows
(excuse my backward numbering which
has its reasons):
5. The fully indigent—persons who
need financial assistance for their basic
living needs, as well as for all their
medical care, in order to survive.
4. The wholly medically indigent-persons
of such low income that, while
they can eke out a subsistence life with
respect to food, clothing, and shelter,
need financial assistance for the medical
care of any illness, if it is to be of
adequate quality.
3. The partially medically indigent-persons
whose income and family re-sponsibilities
permit them to meet ordi-nary
living requirements as well as the
costs of minor illness, but who require
financial assistance for the costlier med-ical
care of serious or prolonged ill-ness.
2. The insured self-reliant— persons
whose income and responsibilities per-mit
them to meet ordinary living re-quirements
as well as the cost of minor
illness, and who are protected by some
form of medical care insurance which
covers the costs of major or prolonged
(but not too prolonged) illness.
1. The fully self-reliant — persons
who, with or without insurance, can
meet without assistance all their living
costs as well as all costs of medical
care for any illness, minor or major.
Even this subdivision of the Amer-ican
population into five classes, intri-cate
as it may seem, is really an over-simplification.
As social workers know,
there are various subclasses of fully
indigent under Class 5. Under the prin-cipal
"medically indigent" groups,
Classes 4 and 3, there are numerous
shadings and subdivisions depending
on the type of illness, the availability of
organized medical facilities, the attrib-utes
of the family at the time and
place, and so forth. Under Class 2, the
combinations and ramifications of in-surance
coverage and benefits would
lead to another dozen or so subclasses,
if the scene were fully analyzed. And
even under Class 1, the definition
would have to lead to numerous sub-classes,
unless it were so strictly applied
that only a handful of oil magnates or
movie stars ended up in it.
Yet, this is the kind of demographic
gymnastics that we are led to by the
conceptual premises of this report on
"medical indigency." There are two di-mensions
to medical indigency, as the
reports brings out so well, (a) the per-son
and (b) the medical requirements,
12 THE HEALTH BULLETIN March, 1965
and the range of variability along both
these dimensions is very long, indeed.
It is hard enough to make a sound judg-ment
along the first dimension, but to
do it along the second, and then along
both in combination—if this is done
scientifically and objectively— is an enor-mous
administrative task. I was particu-larly
struck by the somewhat cavalier
brevity of the report on the need for
"information and adequate interpreta-tion
on . . . anticipated duration and
estimated cost of medical care" for a pa-tient.
Prognosis is tough enough for the
soundest clinician, and attaching price
tags to it as well calls for the com-bined
wisdom of a William Osier and
a John M. Keynes.
Mrs. Alt cogently points out that 42
per cent of American families—with in-comes
in the $3,000 to $7,500 range-are
vulnerable to medical indigency; she
believes that "a majority of these (fami-lies)
will fall at some time within the
medically indigent group." I suspect that
this is a conservative estimate, but the
administrative task is to identify which
individual families in this "majority"
and which dates within this "time"
yield an affirmative decision on medical
indigency.
Small wonder that all these complexi-ties
and uncertainties about the imple-mentation
of the concept of medical in-digency
have led most industrialized na-tions
of the world to give it up com-pletely.
In its place, they have substi-tuted
systems of social insurance for
medical care and networks of public
clinics and hospitals for virtually all who
come to their doors. Almost all countries
have done this for the total population
with respect to the costliest element in
health service—care in a general hos-pital—
including most recently our Ca-nadian
neighbor to the north.
The objection to the "medical in-digency"
concept lies not only in its
enormous administrative complexity—
which must of course be translated into
the costs and time and efforts of skilled
professional personnel. These efforts
could be far better spent on social case-work
and other positive services. More
important are its implications for the
kind of medical care that people would
and do receive in a class-structured sys-tem.
A class-categorization of people for
entitlement to medical care—whether
into five levels as implied by this report
or into ten levels or into two levels-leads
inevitably into class-levels of med-ical
service. The evidence for this is
around us everywhere��� in the crowded
public clinic compared with the private
medical office, in the public ward surg-ery
by the assistant resident versus
the private room surgery by the board-certified
specialist, in the dental ex-traction
versus the root-canal therapy.
This, of course, was certainly not the
intention of the dedicated people who
have produced the report that Mrs.
Alt has summarized. But there is world-wide
evidence that for reasons that are
at once economic, political, and atti-tudinal
this is where it leads us.
We have been moving forward in
America with a democratization of med-ical
care through the vast growth of
health insurance. We still have a long
way to go, but progress is being made
every day. Here in California, there is
serious talk of emerging from our 19th
century county hospital system for the
separate care of the poor. The Social
Security Act pension system was a mile-stone
in helping to achieve economic in-dependence
and dignity for nearly all
aged persons, without a means test. I
hope we do not now encourage a move-ment
backward, along the path laid out
by the Kerr-Mills amendment, into a
legally frozen class-ridden pattern for
an American's entitlement to general
medical care.
Milton I. Roemer, M. D.
Professor of Public Health, University
of California School of Public Health,
Los Angeles, Calif.
March, 1965 THE HEALTH BULLETIN 13
IMMUNIZATIONS START
AT HOME
Members of the Staff of the State
Board of Health took their own medi-cine
Monday morning when they lined
up for needed immunizations as the
State Board launched a 17 month State-wide
program urging early immuniza-tion
especially of the new-born and of
pre-school age children. Shown in the
picture is Mollie Murray, who operates
the Snack Bar in the Cooper Memorial
Health Building, receiving one of her
shots from Mrs. Ruth L. Edwards, pub-lic
health nurse of the Wake County
Health Department. Looking on, from
the left, are Dr. Jacob Koomen, Jr., As-sistant
State Health Director; Dr. Ronald
H. Levine, field epidemiologist of the
State Board; and Dr. William E. Bellamy,
Jr., of the Wake County Medical So-ciety.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
Lenox D. Baker, M.D., President Durham
John R. Bender, M.D., Vice-President Winston-Salem
Ben W. Dawsey, D.V.M Gastonia
Glenn L. Hooper, D.D.S. Dunn
Oscar S. Goodwin, M.D. Apex
D. T. Redfearn, B.S. Wadesboro
James S. Raper, M.D. Asheville
Samuel G. Koonce, Ph.G. Chadbourn
John S. Rhodes, M.D. Raleigh
EXECUTIVE STAFF
J. W. R. Norton, M.D., M.P.H. State Health Director
Jacob Koomen, Jr., M.D., M.P.H. Assistant State Health Director
J. M. Jarrett, B.S. Director, Sanitary Engineering Division
Martin P. Hines, D.V.M., M.P.H. Director, Epidemiology Division
W. Burns Jones, M.D., M.P.H. Director, Local Health Division
E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division
Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division
Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division
James F. Donnelly, M.D. Director, Personal Health Division
14 THE HEALTH BULLETIN March, 1965
No Certainty In Eldercare
The problem of the elderly ill who can not afford adequate medical care
has been with us for a long time, but the latest Louis Harris survey puts it in
clear perspective: It is the number one domestic issue in the country today. More
than 32 per cent of all American families have an elderly member in need of
special medical attention, and less than half of them can afford it, the Harris
survey found.
That helps explain President Johnson's determination to enact the Medicare plan
that would provide guaranteed hospital care for the elderly under Social Security.
It is the high cost of hospital services which overwhelms the meager financial
resources of so many old people.
The Medicare plan is under attack by the American Medical Association which
proposes an alternative it labels as the "Eldercare" plan. This alternative would,
the association says, authorize medical and surgical payments as well as pay-ments
for hospital bills. It would indeed authorize a wide range of health care
services. But it would guarantee very little.
Under Eldercare, it would be up to the states to put up matching funds and
decide the level of medical care provided. This could be as little as one day in
a hospital and one visit annually from a doctor.
Some state legislatures would enact a niggardly program because of dominant
conservative control in state government. Many more, such as North Carolina,
would do the same because they can afford no better. This is not the only
grave fault of the Eldercare plan, but it is one of the bigger ones not even hinted
at in the glowing AMA sales pitch.
In contrast, the elderly would know what they were getting under Medicare
and they could depend on it: Sixty days of post-hospital care, 240 days of home-health
visits, and out-patient diagnostic service every year.
Editorial in Raleigh (N. C.) News and Observer, March 2, 1965
March, 1965 THE HEALTH BULLETIN 15
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DATES AND EVENTS
April 20-22-Eastern Branch, NCPHA,
Blockade Runner Hotel, Wrightsville,
Beach.
April 22-23-Annual Meeting, N. C.
Tuberculosis Association, Robert E.
Lee Hotel, Winston-Salem.
April 22-24—Seventh Southern Regional
Institute on Recreation with the III
and Disabled, Chapel Hill.
April 23-24-Annual Meeting, N. C.
Chapter of the American College of
Surgeons, Blockade Runner Hotel,
Wrightsville Beach.
April 23-24-Annual Meeting, N. C.
Society of X-Ray Technicians, Ashe-ville.
April 25-28—Southeastern Psychiatric
Association, Annual Meeting, Pine
Needles Lodge, Southern Pines.
April 27-29-N. C. PTA Convention,
Jack Tar Hotel, Durham.
April 28-May 1—American College
Health Association, Miami Beach, Fla.
April 29-30— President's Committee on
Employment of the Handicapped,
Washington, D. C.
May 1-5—Medical Society of the State
of N. C, Queen Charlotte Hotel,
Charlotte.
May 1-7-National Mental Health Week.
May 2-8-N. C. Special Week on Ag-ing.
May 3-7— National League for Nursing
(Biennial Convention), Civic Auditor-ium,
San Francisco, Calif.
May 4-5—Association of American Phy-sicians,
Atlantic City, N. J.
May 5-6—Annual Meeting, N. C. Die-tetic
Association, Jack Tar Hotel,
Durham.
May 6-8—American Pediatric Society,
Philadelphia, Penn.
May 7—Annual Conference of N. C.
Rural Safety Council, YMCA, Raleigh.
May 9-15-National Hospital Week.
May 1 0-1 2—American National Red
Cross, Detroit, Mich.
CONTENTS
Medicare Awaits Senate Action 2
How the AMA Supported Eldercare
Bill Compares with the Admin-istration
Sponsored Medicare
Proposal 3
Medicare Vs. Eldercare 7
Determining Medical Indigency 9
Principles proposed by National
Council on the Aging
Comments by Dr. Milton I.
Roemer
Immunizations Start at Home 14
No Certainty in Eldercare 15
16 THE HEALTH BULLETIN March, 1965
The Officio! Publication Of Carolina State Board of Health
V, %Q*r
flPZU i9bf
in
' .-'"
«'.
llH
A promising theory of modern cancer research holds that certain indi-viduals
(represented by the shaded fiingerprints on our cover) share
symptoms indicative of a high cancer risk. If this proves true, doctors
will be able to identify, among a typical group like the one below,
persons who are most likely to develop cancer and who therefore need
more frequent and more specialized treatment. For more, see page 3.
THE HEALTH BULLETIN April, 1965
"I have a theory that virtually all agents which can produce cancer, produce other
types of changes first . . . The problem has been to launch an all-out search for
such symptoms, which is just what we're doing in the cancer prevention study."
"In a fundamental sense, all health is one nowadays. The battle against cancer in-evitably
involves fresh insights into what it takes to live and be healthy in a
shrinking and increasingly complex world. Evolution has not adapted us to many
of the things we are introducing into our environment, tensions as well as
drugs . . ."
AVisit With Cuyler Hammond
By JOHN E. PFEIFFER
We call on the head of the American Cancer Society's
Statistical Research Station who tells how the disease is
being studied with statistics, surveys and data processing.
Reprinted by permission from THINK
Magazine, Copyright 1965 by International
Business Machines Corporation.
IN the last analysis, all medical pro-gress
can be traced to clinical find-ings,
to the recognition of significant
differences between people who come
down with a particular disease and
people who don't. A classical example
is the 18th century "superstition" that
April, 1965 THE HEALTH BULLETIN
milkmaids were protected from small-pox
by previous infections of a related
but far milder disease, cowpox, a notion
that led to the development of success-ful
vaccines. Today, as in times past,
advances continue to come from shrewd
observations, which are often based on
highly sophisticated methods of gather-ing
data and making inferences.
Such methods are being used in the
increasingly intensive fight against can-cer,
in many ways the most challenging
medical problem of our times. For
more than forty years, the leader in this
fight has been the American Cancer
Society, Inc., which, in addition to sup-porting
laboratory and hospital research,
has launched large-scale surveys de-signed
to provide new knowledge
about the causes and prevention of
cancer—an activity directed by E. Cuyler
Hammond, head of the Society's Sta-tistical
Research Station and an inter-nationally
noted master of the subtle
art of evaluating facts.
A Yale graduate and former indus-trial
health investigator at the National
Institutes of Health, Hammond is most
widely known for findings on smok-ing
and health. But his interests ex-tend
beyond the problem of lung can-cer,
as I learned when I spoke with
him recently in New York, where Am-erican
Cancer Society headquarters are
located.
Hammond is a quietly intense, lean-faced
man in his early 50's. He chooses
his words carefully before responding
to a question and then starts talking
at a rapid rate, looking at you with
sharp eyes and usually punctuating
the end of his answers with a smile.
Dedicated to the full-time job of an-alyzing
ideas that can be expressed pre-cisely
and tested (he works most nights
and every weekend), he approaches
cancer problems from a broad point of
view.
"The greatest achievement of the last
hundred years," he told me, lighting up
his pipe, "isn't the hydrogen bomb or
space travel or more washing machines.
These things and a good deal more are
all by-products of a more basic devel-opment,
the spectacular improvement
in health which has given us time for
longer periods of education and for
longer productive lives. If you look
back at the records for this country
you can see that the big killers were,
as they still are in some parts of the
world, infectious and parasitic diseases
such as malaria, smallpox and tuber-culosis.
The huge decline in death rates
has been above all a result of preven-tive
medicine, slum clearance and san-itation
and vaccines and other public
health measures.
"Our biggest problems today are
heart disease, cancer and other degen-erative
illnesses which generally take
years or decades to develop and tend to
The Health Bulletin
First Published—April 1886
The official publication of the North Carolina
State Board of Health, 608 Cooper Memorial Health
Building, 225 North McDowell Street, Raleigh, N. C.
Published monthly. Second Class Postage paid at
Raleigh, N. C. Sent free upon request.
EDITORIAL BOARD
Charles M. Cameron, Jr., M.D., M.P.H.
Chapel Hill
John T. Hughes, D.D.S., M.P.H.
John C. Lumsden, B.C.H.E.
Mary Ann Farthing, M.S.
Jacob Koomen, Jr., M.D., M.P.H.
Bryan Reep, M.S.
John Andrews, B.S.
Glenn A. Flinchum,
H. W. Stevens, M.D.
B.S.
M.P.H., ASHEVILLE
Editor—Edwin S. Preston, M.A., LL.D.
Vol. 80 April, 1965 No. 4
THE HEALTH BULLETIN April, 1965
•';:->
"The past thirty years or so have seen
a notable increase in cure rates, one
major reason being the American Cancer
Society's public education program."
strike later in life—and here again a
central goal, together with improved
treatments and cures, is prevention. As
in the past, we must draw heavily on
the techniques of epidemiology, the
study of circumstances under which dis-ease
occurs in the human population.
We want to discover critical causative
factors, factors which increase the prob-ability
of sickness and death."
Accent on Statistics
Hammond is well aware of the dif-ficulties
of such research. For relatively
minor ailments like athlete's foot, new
treatments may be tested on patients
without running serious risks. But when
it comes to major diseases, investigators
can't perform extensive experiments on
human beings. Furthermore, animal
experiments conducted under strictly
controlled laboratory conditions have
only a limited, remote bearing on the
uncontrolled and complex conditions
of everday life. So the accent is neces-sarily
on statistics based upon obser-vations
rather than experiments. Since
it is quite possible to draw invalid con-clusions
from valid facts, I asked about
the pitfalls of the statistical approach.
"Let me give you an example," Ham-mond
replied, as he paused to relight
his pipe. "During World War II, I was
stationed at the Air Force School of
Aviation Medicine in Texas, and we
were all very much concerned with the
extremely high accident rate among
pilots undergoing training. Some psy-chiatrists
had the theory that most of
the accidents were occurring among
'accident-prone' men, individuals psy-chologically
predisposed to carelessness
resulting in accidents. So, pilots recently
involved in aircraft accidents were ask-ed
detailed questions about their child-hood
accidents—and they recalled a
great many falls, broken bones and
other mishaps. On the other hand, pilots
who had never been involved in an
aircraft accident reported very few
childhood accidents. Apparently the ac-cident-
prone theory had been confirm-ed.
"I was immediately suspicious, how-ever.
For one thing, the results were
too darned good. Hardly anything seem-ed
to have happened during the child-hoods
of pilots with no training ac-cidents,
while everything seemed to
have happened to less fortunate pilots.
I suspected that there might have been
some bias in response, because an air-craft
accident can be a terribly shaking
experience. A man may be in such a
state of confusion and guilt afterwards
that you could probably get him to
'confess' to beating his own mother.
This is always one of the problems
with the 'retrospective' or historic sur-vey,
that is, a survey involving people
April, 1965 THE HEALTH BULLETIN
who are already victims of the condition
you are trying to learn about. Emo-tionally
upset people cannot be count-ed
on to give unbiased reports.
"So we decided to do a prospective
or follow-up survey, questioning about
twenty-five hundred consecutive pilots-to-
be before they went into training.
Then we put the records away in a
safe. More than a year later, we went
back and compared the records of pilots
who had been in accidents during their
first year of training and pilots who
hadn't. As far as the number and
severity of childhood mishaps were
concerned, absolutely no significant dif-ference
existed between the two
groups. In other words, it was useless
to question applicants about their child-hood
accidents as a means of eliminat-ing
men most likely to be involved in
an aircraft accident.
"This experience was very much on
my mind 15 years ago, when we knew
much less about smoking and cancer,
and most of our statistics were based
on retrospective surveys. But many of
us, aware of the possibility of a bias
factor and other problems, were frankly
skeptical."
Hammond explained that the next
step, as in the Air Force study, was
an ambitious prospective survey—the
first of its kind in this country and a
task which only an institution like the
American Cancer Society could under-take.
In 1951, it mobilized more than
22,000 volunteers, many of them form-er
cancer patients, to obtain complete
information about the smoking habits of
some 188,000 presumably healthy men
between the ages of 50 and 70. In or-der
to avoid possible bias on the part
of the volunteers, the men were not in-terviewed;
they were simply asked to
fill out questionnaires. Having built up
considerable good will among physi-cians
and hospital authorities over the
years, the Society had ready access to
medical details on those who died of
cancer. When the time came for follow-up
studies two years later, 1 1,870 men
had died, 2,249 of them from cancer.
Analysis of the records confirmed
retrospective studies in showing a de-finite
association between cigarette
smoking and cancer. "Just as impor-tant,"
says Hammond, "we had shown
that follow-up studies were feasible on
a very large scale, if you have a good
organization behind you and plenty
of volunteers. If we'd had to pay them
what they were worth, it would have
cost us several million dollars.
"Soon we began thinking about our
ultimate objective: means of preventing
many if not all types of cancer. In or-der
to obtain information directed to-ward
this goal, an even more extensive
epidemiological study was required, one
which would deal with other factors as
well as smoking, other forms of cancer,
and women as well as men. We worked
out a most thorough questionnaire.
Among other things it included occupa-tion,
details of present health status,
education, eating and drinking habits,
hours of sleep per night, and so on.
The survey started more than five years
ago, with 68,000 volunteers this time.
The plan was to interview some million
people aged 30 or older, and to follow
up every one of them six times at an-nual
intervals.
"Right now we're finishing our fifth
follow-up and are beginning to analyze
the data. We already have about three
hundred bits of information about each
person, so you can appreciate the mag-nitude
of our task and why we've had
to develop special ways of using elec-tronic
computers. In our work spectac-ular
calculating speeds aren't nearly as
important as effective man-machine
communications. Since I like to plan as
I go, what matters to me is how long it
takes from the time I get an idea—
a
hunch, if you will—to the time I see an
THE HEALTH BULLETIN April, 1965
actual printed table. Then I want to be
able to modify my idea, or try another
one in a reasonable time, and get a
quick answer again. It's something like
having a conversation with the comput-er."
What are the objectives of the cur-rent
survey?
"Part of the story is indicated in the
official name, 'Cancer Prevention Study.'
The past thirty years or so have seen a
notable increase in cure rates, one
major reason being the American Can-cer
Society's public education program.
The emphasis on danger signals, per-sisting
symptoms such as hoarseness or
unhealing sores which may result from
early stages of the disease, has certain-ly
helped alert people to the impor-tance
of prompt treatment. But we want
to do better than that, to carry the
offensive one step further.
"What we would like to do is dis-cover
complaints that appear before
the disease process has a chance to
establish itself. I have a theory that
virtually all agents which can produce
cancer, produce other types of changes
first. For example, lung cancer is al-ways
preceded by an appreciable in-crease
in the number of cell layers in
the bronchial tubes, more mucus and
other effects which very probably de-velop
years or decades before cancer.
It also happens that such tissue changes
within the body may be associated with
symptoms like coughing and shortness
of breath.
All-Out Search
"The problem hbs been to launch an
all-out search for such symptoms, which
is just what we're doing in the cancer
prevention study. We are looking for
signs on the broadest possible basis
because, as things stand now, we don't
know exactly where to look. We have
asked our million persons how much
exercise they get (none, slight, mod-erate,
heavy), which of six medicines
they use (never, seldom, often), wheth-er
they experience various degrees of
some two dozen physical complaints,
and a host of other questions. We hope
to discover that certain of these factors,
"In a fundamental sense, all health is
one nowadays. The battle against can-cer
inevitably involves fresh insights in-to
what it takes to live and be healthy
in a shrinking and increasingly complex
world."
April, 1965 THE HEALTH BULLETIN
or "clusters of factors, may serve as
warnings of impending cancers."
To Save More Lives
Nothing of this scope has ever been
t|ied before, and Hammond pointed out
that it is still much too early to predict
just how the new approach will work
out. But the American Cancer Society
is conducting other important statistical
studies, and he cited one of them as an
example of future possibilities. A pro-spective
or follow-up study is under
way involving the occurrence of cervical
cancer among more than eighty thou-sand
women in Toledo, Ohio. The main
purpose is to investigate a tentative
finding which, if confirmed, might
mean the saving of many lives.
"Earlier studies had suggested the
existence in the population of a group
of 'high-risk' women—women who re-ported
any kind of cervical complaint
such as discharge or bleeding. Remem-ber
that, as far as medical science can
tell, they were absolutely free of cer-vical
cancer. Yet follow-up observations
indicate that they are 10-to-15 times
more likely to contract the disease than
women who did not have such com-plaints.
Another important point is that
they made up a small proportion of
the total group, about one out of seven
women.
"Now we're checking these results,
among others, with the aid of an elec-tronic
computer and expect to have our
answers within six months or so. As-suming
that our preliminary findings are
indeed valid, we shall make a strenuous
effort to persuade these high-risk wo-men
to report for special medical ex-aminations
every six months. You can
see the possibilities here. Most cer-vical
cancer seems to occur in a group
that can be identified beforehand, and
the chances are good that by focusing
on this group we may be able to lower
death rates appreciably. Furthermore,
our large-scale cancer prevention study
is designed to locate other high-risk
groups, if they exist.
"This may also be the best way to
get back to basic causes, a central aim
of all our research. If high-risk groups
are found and examined two or more
times a year, medical investigators will
have a unique opportunity to follow
more closely than ever before the long
and intricate process whose last stages
are what we call cancer. According to
one theory, the one I favor, this process
depends ultimately on a special kind of
genetic change.
"Think of the body's cells as popula-tions
of living things. They are con-tinually
dying and being replaced by
newborn cells and, as in all popula-tions,
there are mutations or 'sports' in
every new generation. Among the
mutants some cells have the potential
ability to multiply abnormally. They
will not do so, however, unless condi-tions
are right—that is, unless their en-vironment
inside the body is altered in
a suitable way. For example, tobacco
smoke may alter the environment so as
to favor lung-cell mutants capable of
malignant growth at the expense of
normal tissue. A kind of natural selec-tion
may be working in the body, and
our research will help us evaluate this
theory and others."
Toward the end of our talk, Ham-mond
emphasized the widening scope
of the current large-scale survey. The
primary purpose is naturally to cure
and prevent cancer, but a prospective
study by its very nature provides signi-ficant
information about a variety of
conditions. For example, out of the mil-lion
persons originally interviewed five
years ago about forty-five thousand
have already died—and, as expected, a
large proportion of them died from
heart and circulatory diseases. So it is
hardly surprising that results are of con-siderable
interest to specialists in many
fields.
THE HEALTH BULLETIN April, 1965
"An enormous amount of data will
have to be processed here, with im-plications
for the social as well as the
medical sciences. Many of our subjects
have moved, and in tracing them and
obtaining their records we are collect-ing
material about the shift of people
from country to city, about the effects
of migration on health and the family.
In other words, we shall have an in-credibly
large number of associations
of significant relationships to explore.
We receive requests for information
from business schools, sociologists, psy-chologists
and many other sources. But
we have hardly scratched the surface as
far as a full analysis of the data is con-cerned.
That could take another decade,
or another generation.
All Health Is One
"In a fundamental sense, all health
is one nowadays. The battle against
cancer inevitably involves fresh insights
into what it takes to live and be healthy
in a shrinking and increasingly com-plex
world. Evolution has not adapted
us to many of the things we are intro-ducing
into our environment, tensions
as well as drugs and other chemicals.
We must adjust culturally .and a most
important example of that is the con-tinuing
drive to prevent disease and
raise health levels everywhere. This is
the challenge which confronts us all,
and if past successes are any indication,
I believe we can look forward to sig-nificant
progress in the future."
Research Being Done in
Public Health Practices
Progress on organizing research into
the evaluation of public health practices
was reported at the annual meeting of
the American Public Health Association
last year by Dr. Vlado A. Getting. The
paper presented by the Professor of
Public Health Practice at the University
of Michigan's School of Public Health
was developed by members of the mul-tidisciplinary
research team which is
conducting the study under a grant
from the Public Health Service.
Presently-used methods of evaluation
were declared to be of little value be-cause
many depended in large part on
arbitrarily established standards or
measurement of effort which is equated
with accomplishment. Another criticism
was that standards which might be suit-able
in one place or under one set of
circumstances might not be in another.
The study at the University of Michi-gan
was set up, Dr. Getting said, to
work toward: "the development of
tools for the evaluation of program ef-fectiveness,
the exploration of factors
that motivate people to follow health
recommendations, and the identifica-tion
of factors that influence an or-ganization's
ability to make desirable
program changes."
In further definition of the objec-tives
of the study, Dr. Getting stated
the evaluation methods which it
sought to develop should: permit a true
assessment of the extent to which ob-jectives
are attained; be in such form
as to permit a self-evaluation by the
April, 1965 THE HEALTH BULLETIN
operating agency; be applicable to any
public health program regardless of
size or complexity; and reveal the prob-able
source or location of program
weaknesses where such exist.
"Such evaluation devices will permit
different localities to use the same
methodological approach to evaluate
quite different health programs," Dr.
Getting said. "Each locality can assess
what it has achieved with respect to
its own locally defined objectives and
needs."
The task of the study group has been
divided into three steps, Dr. Getting
stated: describe programs in precise
terms as to their objectives; measure
actual accomplishment, bearing in mind
the difficulty of measuring directly some
of the qualities of an objective, and
whether any improvement noted may
be due to causes other than the pro-gram
under consideration; validate
measurement devices by use on exist-ing
programs.
To date, Dr. Getting indicated, the
group's work has consisted mainly of
"developing means of describing pro-gram
objectives and activities in a
manner that will permit subsequent
evaluation." For this purpose a "Guide
for Identification of Program Activities
and Objectives" for use by program
personnel of health agencies has been
developed.
"In this guide," Dr. Getting said, "the
work that constitutes the program to be
evaluated must be locally defined. The
instructions suggest only one caution:
If a program is unusually large and
complex, it may be better to subdivide
it and treat the parts as individual pro-grams."
The agencies are asked to list
program activities and their com-ponents,
and the objectives of each
activity. Definition of objectives is re-quested
in "statements that are precise
and complete enough to permit an ac-curate
measurement of the extent to
which they are being accomplished."
According to Dr. Getting, the expres-sion
of program objective should meet
these requirements: "The statement
must refer to a need, situation or con-dition
that is external to the person or
agency conducting an activity ... It
must be stated with sufficient precision
to indicate both quantitative and quali-tative
aspects of desired outcomes."
Dr. Getting said further that "it may
be necessary to identify the validity of
assumptions that underlie the use of
particular activities to achieve particular
objectives, and the assumptions that
link together the several program ob-jectives
and sub-objectives."
There is a probability, Dr. Getting
said, "other approaches to evaluation
of public health practice, such as the
expert survey technique, will be tested
at some future time."
Several other studies were also men-tioned.
Among these were investiga-tion
of the most effective way of de-termining
people's health beliefs and
their actions to protect their health,
and identification of key factors in-fluencing
health agencies to adapt to
meet changing conditions and needs.
Summing up, Dr. Getting stated that
"the program includes research on the
program effectiveness and on the con-ditions
under which health organiza-tions
are able to modify their programs
and organization in the interest of in-creased
effectiveness. Other research
seeks to throw light on personal de-cision-
making processes in health areas,
and to develop a better understanding
of how people are persuaded to change
their health practices. The research pro-gram
is beginning to produce experi-mental
tools which will have to be field
tested over a period of years but pro-gress
to date indicates that the results
will be useful in the difficult but high-ly
important task of strengthening
community health practices."
10 THE HEALTH BULLETIN April, 1965
Choose
Your
Own
attitude toward their use, says To-day's
Health, the magazine of the
American Medical Association.
Today, hair color is not just accept-able—
it is high fashion, says the mag-azine
article, prepared by a noted der-matologist
and a cosmetic chemist, in
consultation with the Committee on
Cutaneous Health and Cosmetics of the
AMA.
This year Americans are expected to
spend one hundred million dollars on
hair-coloring products. While women
are the principal users, many men also
use hair color.
Hair color can be modified in one of
two ways. The natural pigment of the
hair can be bleached, and thereby light-ened,
or artificial coloring can be ap-plied.
Often both operations are car-ried
out to produce the desired effect.
The importance of reading and ob-serving
the directions for using all
hair-coloring products cannot be over-emphasized.
This is especially true of
IQI* the permanent colors. They are most
difficult to remove. Modern hair-color-ing
products will give excellent results
for most users, but only if the instruc-tions
are carefully followed.
One of the major causes of dissatis-faction
by home users is the mistaken
belief that a single application of hair
color will produce any desired shade.
This is not so. It is quite simple to cover
gray hair or to color light hair a darker
III shade, but it is not yet possible for
a single application of any hair coloring
to change black or dark brown hair to
a pale blond.
Peroxygen compounds, especially
hydrogen peroxide, are widely used in
bleaching hair. Six per cent hydrogen
peroxide solution is the standard
strength, and is safe, if proper pre-cautions
are observed. Stronger concen-
The last few years have seen a flood trations can produce burns and blister-of
new hair-coloring products, and ing of the scalp. Excessive bleaching
hand-in-hand came a change in public can leave the hair harsh, strawlike and
April, 1965 THE HEALTH BULLETIN 11
Coh
of
Hoi
brittle.
Largest and most important group
of hair dyes are those based on
synthetic organic chemicals. These are
in three categories—oxidation dyes,
semi-permanent dyes and temporary
rinses. Oxidation dyes are the most
widely used.
Most professional hair coloring or
tinting is now done with oxidation
dyes, and they also have become pop-ular
for home use. They are the only
products that color the hair quickly
and yet produce all varieties of natural
hair shades which are lasting.
The biggest question about oxida-tion
dyes is their hazard. It has been
estimated that about one person in 50,-
000 will have an unpleasant reaction,
such as a skin rash, swelling about the
eyes, redness and crusting of the face
and neck, plus itching and discomfort.
The victim, while uncomfortable, should
be aware that this is not a serious ill-ness
and that she will recover.
Included with each package, accord-ing
to federal regulations, are instruc-tions
for performing a patch test before
using oxidation dyes, to determine
whether there is an allergy. The test
should be repeated before each applica-tion
of the dye. And the dyes should
not be used on eyebrows or eyelashes,
because of possible danger to the eye.
In addition to the oxidation dyes,
there also are semi-permanent dyes,
which usually will wash out with one
shampoo; acid color rinses, using
harmless organic acids; vegetable dyes,
principally henna, and metallic dyes, no
longer as popular as in the past.
If you decide to change the color of
your hair, and if you decide to do it
yourself rather than seek a professional
job, the important thing to remember
is to read the instructions on the label
and the package insert, and follow
them carefully. These are for your own
safety and protection.
Film On Occupational
Health Is Now Available
The Occupational Health Division of
the U. S. Department of Health, Educa-tion
and Welfare has made available
to the State Board of Health a new
motion picture, "The Hidden Hazards."
This film is obtainable on loan from the
Film Library of the State Board, Box
2091, Raleigh.
"The Hidden Hazards" tells the story
of occupational health. It shows how
man has progressed from the early
trades with obvious dangers, today's
complex operations, in which the haz-ards
may be less evident. See what is
being done to protect employed men
and women from those health hazards
which arise in the course of their work.
Starting on a dramatic note—the near
fatal poisoning of a metal shop worker
-the HIDDEN HAZARDS depicts the
growth of occupational health. The
film traces the change in attitudes and
practices over the years. The apathy of
ancient times, when slaves carried on
the dangerous trades, has gradually
been replaced by action to safeguard
worker health.
Today everyone recognizes that cer-tain
kinds of work are more hazardous
than others. Sometimes the danger
comes from the conditions under which
men work. Sometimes it lies in the
materials they use. Often workers are
surrounded by dangers they cannot see.
Occupational health presents a chal-lenge
of vital concern to all Americans.
It is our hope that this new 28 1/2-
minute, 16 mm, black-and-white, sound
film will be widely used for showings
before civic and fraternal organizations,
women's clubs, and business and labor,
as well as professional, groups. It may
also be of interest to secondary school
students from the standpoint of career
opportunities.
12 THE HEALTH BULLETIN April, 1965
HOPE FOR HEARTS-When the former
Hope Cooke, newly crowned queen of
the tiny Himalayan kingdom of Sikkim,
recently visited her cousin, Mrs. R.
Phillip Hanes of Winston-Salem, alert
Heart Association volunteers posed Her
Majesty with a "Hope for Hearts" post-er.
"Hope for Hearts" is the theme of
the North Carolina 16th Annual Meet-ing
and Scientific Sessions (Durham,
May 20-21) which will feature special
sessions for the general public and lay
Heart Association Volunteers as well as
for family physicians.
DIAL "H" FOR HEART — Five-year-old Sheila Dial, who recently underwent heart
surgery at Duke University Medical Center, receives a surprise visit from North
Carolina's Heart Mother of the Year, Mrs. Walter S. Cobb, herself a "graduate"
of heart surgery. Mrs.
Cobb is one of several
hundred North Carolina
Heart Association Volun-teers
who will be in
Durham on May 20-21
for the State Heart
Group's 16th Annual
Meeting. Looking on,
above right, is Mrs. Mel-vin
Dial, young Sheila's
mother.
April, 1965 THE HEALTH BULLETIN 13
Community Safety
Courses Being
Offered
Educational opportunities at both the
graduate and continued education level
in the field of community safety were
announced recently by the Department
of Public Health Administration, School
of Public Health, University of North
Carolina at Chapel Hill.
Expanding a program initiated three
years ago, the department will enroll
six graduate students in the curriculum
leading to a Master of Public Health
degree for the academic year beginning
September 1965. Up to 30 students will
be accepted for the short course dealing
with program development techniques
in accident control, which will be held
May 31 -June 4, 1965.
"The graduate program is open to
persons from the fields of education,
nursing, engineering, social science,
medicine, and allied fields of interest
who are seeking careers as accident
control specialists in a local, state, or
national health agency or in a private
organization," Dr. Charles Cameron,
Professor and program director, said.
"Through a special grant from the
U. S. Public Health Service, financial
support is available for qualified stu-dents
who are accepted in the master's
program," stated Dr. Cameron. "Inter-ested
persons are urged to contact the
department without delay."
Applications are now being accepted
for the 1965 short course, according to
Miss Janice Westaby, Assistant Profes-sor
and co-director of the program. In-formation
can be obtained by writing
to the Accident Control Program, De-partment
of Public Health Administra-tion,
UNC School of Public Health,
Drawer 229, Chapel Hill, North Caro-lina.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
Lenox D. Baker, M.D., President Durham
John R. Bender, M.D., Vice-President Winston-Salem
Ben W. Dawsey, D.V.M Gastonia
Glenn L. Hooper, D.D.S. Dunn
Oscar S. Goodwin, M.D. Apex
D. T. Redfearn, B.S. Wadesboro
James S. Raper, M.D. Asheville
Samuel G. Koonce, Ph.G. Chadbourn
John S. Rhodes, M.D. Raleigh
EXECUTIVE STAFF
J. W. R. Norton, M.D., M.P.H. State Health Director
Jacob Koomen, Jr., M.D., M.P.H. Assistant State Health Director
J. M. Jarrett, B.S. Director, Sanitary Engineering Division
Martin P. Hines, D.V.M. , M.P.H. Director, Epidemiology Division
W. Burns Jones, M.D., M.P.H. Director, Local Health Division
E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division
Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division
Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division
James F. Donnelly, M.D. Director, Personal Health Division
14 THE HEALTH BULLETIN April, 1965
Pesticides Are
Dangerous—
Follow the Directions
No matter how often you use a pes-ticide—
for home, garden, or farm—or
how well you think you know the di-rections,
READ THE LABEL each time be-fore
you start work and FOLLOW THE
DIRECTIONS EXACTLY. The other im-portant
rule is KEEP PESTICIDES AWAY
FROM CHILDREN.
Other suggestions for safe and sen-sible
use of pesticides are:
1. Use a pesticide only when you are
sure it is needed and then use the
one best suited to your needs. The
label on the product explains the
proper uses.
2. Keep pesticides in plainly labelled
container, preferably the one in
which it was bought. Never trans-fer
pesticides to unlabelled or mis-labelled
containers.
3. Store pesticides under lock and
key away from food items and
OUT OF THE REACH OF CHILDREN,
pets, and people who might not be
able to understand their danger.
4. Avoid inhaling dust and fumes and
avoid getting materials on the skin
when handling, mixing, or apply-ing
pesticides.
5. If there is an accident, most pes-ticide
labels advise washing the
affected area with lots of fresh
water in cases of external exposure.
Check the label of the product
before using so you know what to
do quickly if there is an accident.
Also, call a doctor or get the pa-tient
to a hospital immediately.
6. People who suspect special sen-sitivity
to pesticides should consult
an allergist and, if necessary, take
steps to avoid any exposure to
the offending agent.
7. Wash hands thoroughly after using
pesticides and before eating or
smoking.
8. Get rid of used containers in a
way that will not leave package or
leftover contents as a hazard to
people—particularly children— ani-mals,
or plants.
9. Work in well-ventilated area to
avoid inhalation of fumes.
10. Do not spray into the wind.
11. Wear protective clothing, such as
gloves, aprons, goggles, respira-tors,
and masks, when so directed.
12. Change clothing after each day's
operations and bathe thoroughly.
If clothing or skin become con-taminated,
wash the skin and
change to clean clothing. Wash
contaminated clothes before reus-ing.
13. Avoid the fire hazard caused by
smoking,

HEALTH SCIENCES LIBRARY
OF THE
UNIVERSITY OF NORTH CAROLINA
This Book Must Not Be Taken
from the Division of Health
Affairs Buildings. F0UR DAYS
This JOURNAL may be kept oul
and is subject to a fine of FIVE CENTS a day
thereafter. It is DUE on the DAY indicated
below:
Pictures and Personal Sketches of 10 Outstanding Persons
Honored for their contributions to Medical Science.
Modern Medicine's
1965 Distinguished Achievement Awards
(see following pages)
To the men who make the great discoveries in medical
science, to the men who apply them in practice, and to their
teachers, Modern Medicine is privileged to say "well done"
on behalf of the medical profession. The nominations for
the Awards for Distinguished Achievement come from deans
of medical schools, leaders of medical organizations, and
members of the Modern Medicine editorial board. No honor
has a merit higher than the merit of those who wear it, and
this award has taken its luster from the names and achieve-ments
of the men who have won it over the years.
Reprinted with permission from Modern Medicine, the Journal of Diagnosis
and Treatment, (January 4, 1965). Copyright 1965 by Modern Medicine
Publications, Inc.
The Health Bulletin MARY ANN farthing, m.s.
Jacob Koomen, Jr., M.D., M.P.H.
First Published—April 1886 Bryan Reep M.S.
The official publication of the North Carolina
State Board of Health, 608 Cooper Memorial Health
Building, 225 North McDowell Street, Raleigh, N. C. John Andrews, B.S.
Published monthly. Second Class Postage paid at Glenn A. Flinchum, B.S.
Raleigh, N. C Sent free upon request. H. W. STEVENS, M.D.. M.P.H.. ASHEVILLE
EDITORIAL BOARD
Charles M. Cameron, Jr , M.D., M.P.H.
Chapel Hill
John T. Hughes, D.D.S., M.P.H.
John C. Lumsden, B.C.H.E.
Editor-Edwin S. Preston, M.A., LL.D.
Vol. 80 January, 1965 No. 1
THE HEALTH BULLETIN January, 1965
Ten
Outstanding
Physicians
and
Medical
Scientists
Honored
for
Contributions
to
Medical
Science
Photographs and discussion
on following pages
Special recognition for their contribu-tions
to medical science was given this
year to 10 outstanding physicians and
medical scientists as the Editors of
Modern Medicine announced their 1965
Distinguished Achievement Awards.
Nine men and one woman were se-lected
from over 100 outstanding med-ical
leaders nominated by deans of
U. S. medical schools, leaders of pro-fessional
medical organizations and
members of the Modern Medicine edi-torial
board. The announcement of the
awards was made in the January 4 is-sue
of the journal.
January, 1965 THE HEALTH BULLETIN
Initiated in 1934, the Modern Medi-cine
annual awards honor those of the
medical profession who make great and
continuing discoveries in medicine. The
1965 winners join the 280 distinguished
physicians and scientists who have re-ceived
the awards during the past 30
years.
The 1 965 winners are:
Leona Baumgartner, M.D., assistant
administrator for technical cooperation
and research, Agency for International
Development, Washington, D. C, for
her concern with the health of man
manifested by contributions to public
health as a scientist and administrator
in an increasing sphere of influence.
Oscar Creech, Jr., M.D., professor of
surgery and chairman of the department
of surgery, Tulane University, New Or-leans.
Dr. Creech was cited for his de-velopment
of regional perfusion in the
treatment of malignant diseases and
for the impact of his work on cardio-vascular
surgical techniques.
Derek E. Denny-Brown, M.D., profes-sor
of neurology, Harvard University,
and director, neurological unit, Boston
City Hospital. Dr. Denny-Brown was
honored for his application of the ac-cumulated
knowledge in basic biolog-ical
sciences to the elucidation of ob-scure
neurological disorders, giving
hope for their ultimate control.
A. Baird Hastings, Ph.D., professor of
biological chemistry, emeritus, Harvard
University, and head of the laboratory
of metabolic research, Scripps Clinic
and Research Foundation, La Jolla, Cali-fornia.
Dr. Hastings received the award
for his brilliant and imaginative discov-eries
in biochemistry, coupled with a
practical approach to their clinical use,
and for his influence as a gifted teacher.
Hudson Hoagland, Ph.D., executive
director of the Worcester Foundation
for Experimental Biology, Shrewsbury,
Mass. He was selected for his organi-zation
of an outstanding biomedical re-search
institution and for his work as
a scientist and a humanitarian bearing
on the world's problem of an exploding
population.
Chester S. Keefer, M.D., professor of
medicine, Boston University, Boston,
was cited for broad talents as clinician,
investigator, educator, and administrator
that have significantly bettered medical
teaching and practice.
William J. Kolff, M.D., head of the
department of artificial organs, Cleve-land
Clinic, and professor of experiment-al
medicine, Cleveland Clinic Educa-tional
Institute. Dr. Kolff was singled
out for his development of practical
methods for effective hemodialysis and
for investigation and development of
mechanical substitutes for essential bio-logical
structures.
Joseph L. Melnick, Ph.D., chairman of
virology and epidemiology, Baylor Uni-versity,
Houston, was chosen for his
work in basic virology especially with
the enteroviruses, and the development
of methods of stabilizing the poliomye-litis
virus that enhance the safety of
poliomyelitis vaccine.
John P. Merrill, M.D., director, cardio-renal
section of Peter Bent Brigham
Hospital, and associate clinical profes-sor
of medicine, Harvard University,
Boston. Dr. Merrill was honored for
pioneering in tissue transplantation and
scientific studies of compatibility factors
that have provided a biologically sound
approach to kidney transplantation.
Francis D. Moore, M.D., professor of
surgery, Harvard Medical School, and
surgeon-in-chief, Peter Bent Brigham
Hospital, Boston. He received the award
for extensive work on the basic patho-physiology
of the surgical patient that
has widened the surgeon's scope, im-proved
operative results, and promoted
the patient's comfort.
THE HEALTH BULLETIN January, 1965
LEONA BAUMGARTNER, M.D.
concern with the health of man manifested by contributions to public health
as a scientist and administrator in an increasing sphere of influence
Assistant administrator for technical co-operation
and research, Agency for In-ternational
Development, Washington,
D. C.
January, 1965 THE HEALTH BULLETIN
OSCAR CREECH, JR., M.D
development\of regional perfusion for the treatment of malignant disease
and impact on cardiovascular surgical techniques
William Henderson professor of surgery
and chairman of the department of sur-gery,
Tulane University, New Orleans.
THE HEALTH BULLETIN January, 1965
S&*v^Sfe
liii \
DEREK DENNY-BROWN, M.D.
application of the accumulated knowledge in basic biological sciences to
the elucidation of obscure neurological disorders, giving hope for their
ultimate control
James Jackson Putnam professor of
neurology, Harvard University, and di-rector,
neurological unit, Boston City
Hospital.
January, 1965 THE HEALTH BULLETIN 7
A. BAIRD HASTINGS, Ph.D.
brilliant and imaginative discoveries in biochemistry, coupled with a prac-tical
approach to their clinical use, and influence as a gifted teacher
-*>-.*:«rv.:'-=i3
Hamilton Kuhn professor of biological
chemistry, emeritus, Harvard University,
Boston, and head of the Laboratory of
Metabolic Research, Scripps Clinic and
Research Foundation, La Jolla, Calif.
THE HEALTH BULLETIN January, 1965
HUDSON HOfGLAND, Ph.D.
organization of an (outstanding biomedical research institution and work as
a scientist and a humanitarian bearing on the world's problem of an ex-ploding
population
•
Executive director, Worcester Founda-tion
for Experimental Biology, Shrews-bury,
Mass.
January, 1965 THE HEALTH BULLETIN
CHESTER S. KEEFER, M.D.
protean talents as clinician, investigator, educator, and administrator that
have significantly bettered medical teaching and practice
Wade professor of
University.
ledicine, Boston
10 THE HEALTH BULLETIN January, 1965
WILLEM J. KOLFF, M.D.
practical methods for effective hemodialysis and investigation and develop-ment
of mechanical substitutes for essential biological structures
Head of the department of artificial or-gans,
Cleveland Clinic, and professor
of experimental medicine, Cleveland
Clinic Educational Institute.
January, 1965 THE HEALTH BULLETIN 11
JOSEPH L MELNICK, Ph.D.
work in basic virology, especially with the enteroviruses, and development
of methods of stabilizing the poliomyelitis virus that enhance the safety
of poliomyelitis vaccine
Chairman, department of virology and
epidemiology, Baylor University, Hous-ton.
12 THE HEALTH BULLETIN January, 1965
JOHN P. MERRILL, M.D.
pioneering in tissue transplantation and scientific studies of compatibility
factors that have provided a biologically sound approach to kidney trans-plantation
Director, cardiorenal section, Peter Bent
Brigham Hospital, and associate clinical
professor of medicine, Harvard Univer-sity,
Boston.
January, 1965 THE HEALTH BULLETIN 13
FRANCIS D. MOORE, M.D.
extensive work on the basic pathophysiology of the surgical patient that
has widened the surgeon's scope, improved operative results, and pro-moted
the patient's comfort
Moseley professor of surgery, Harvard
University, and surgeon-in-chief, Peter
Bent Brigham Hospital, Boston.
14 THE HEALTH BULLETIN January, 1965
Individual Air Conditioners
Are Being Used
An individual air conditioner provid-ing
cool, clean air for workers exposed
to heat is being used routinely on cer-tain
jobs in industrial plants in the
southern United States.
The simple, low-cost device is de-scribed
by W. F. Lienhard, M.D., San
Diego, Calif., J. P. Hughes, M.D., Oak-land,
Calif., and T. A. Brassette, AA. E.,
New Orleans, in the current (September)
Archives of Environmental Health, pub-lished
by the American Medical Asso-ciation.
It could be particularly helpful for
workers whose tolerance for heat has
been reduced by aging, heart disease,
or other physiological impairment.
Comparable observations on acclima-tized
workmen with and without the de-vice
during periods of identical work in
a severely hot environment resulted
in a threefold reduction in heat loss, a
25 per cent reduction in total heart
beat, and a 50 per cent reduction in
the rate of body temperature rise for
the air-conditioned man, according to
the researchers.
The entire weight of the personal air-conditioner
is only 19 ounces, accord-ing
to the report. The air is cooled
by a vortex tube, invented in 1931 by
a French metallurgist, George Ranque.
Standard industrial compressed air is
delivered through a hose to the tube
attached by a belt to the man's waist.
The tube converts compressed air at
120 degrees Fahrenheit to a steady
flow at 65 F.
Each worker has a "breakaway" coup-ling
so he can detach himself from the
air supply hose simply and quickly in
case of danger. Hoses 150 feet in
length provide the worker a high de-gree
of mobility.
None of the earlier systems proposed
for individual air conditioning has been
widely adopted in industry because
in general they have been too complex
and too costly for day-to-day use on
most jobs, the researchers commented.
Vortex tube units with accessory equip-ment
are commercially available. The
vortex tube alone costs less than $75.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
Lenox D. Baker, M.D., President Durham
John R. Bender, M.D., Vice-President Winston-Salem
Ben W. Dawsey, D.V.M Gastonia
Glenn L. Hooper, D.D.S. Dunn
Oscar S. Goodwin, M.D. Apex
D. T. Redfearn, B.S. Wadesboro
James S. Raper, M.D. Asheville
Samuel G. Koonce, Ph.G. Chadbourn
John S. Rhodes, M.D. Raleigh
EXECUTIVE STAFF
J. W. R. Norton, M.D., M.P.H. State Health Director
Jacob Koomen, Jr., M.D., M.P.H. Assistant State Health Director
J. M. Jarrett, B.S. Director, Sanitary Engineering Division
Martin P. Hines, D.V.M., M.P.H. Director, Epidemiology Division
W. Burns Jones, M.D., M.P.H. Director, Local Health Division
E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division
Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division
Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services J>iri
James F. Donnelly, M.D. Director, Personal Health Division
January, 1965 THE HEALTH BULLETIN 15
THE HEALTH BULLETIN
P. O. Box 2091
Raleigh, N. C. 27602
LIBRARIAN
DIVISION OF HEALTH APTAl
N.C. ,VEM. ffOSP. U. M CHAPEL HILL, N.C.
If you do NOT wish to
tinue receiving The Health
letin, please check here
GOdfiM
Official Publication Of The North Carolina Stare Board of Health
j^A***
John Atkinson Ferrell, M.D., Dr.P.H.
December 14, 1880 - February 17, 1965
Fe,b, fits'
John A. Ferre
The miraculous advance in a man's lifetime in public health in North Carolina
and the world could be no better marked than by the service of Dr. John A. Ferrell
who died here Wednesday night. He was, of course, as State Health Officer Dr.
Roy Norton said, "one of the outstanding physicians of all time native to North
Carolina." Perhaps the mark of his greatness was that in his quiet, useful, elder
years here, as director of the State Medical Care Commission, many of the health
dangers he confronted as a young man had all but disappeared.
He was only a young Duplin County practitioner in his twenties when in the
first decade of this century he became assistant State Health officer concerned
with combatting such plagues as typhoid fever and hookworm. Not everybody
approved when, working with the Sanitary Commission and the Rockefeller
Foundation, he extended his work in the campaign against hookworm. Some
Southern patriots resented statements that much backwardness in the South
resulted from this parasite which attacked so many rural people. Some con-sidered
the statements Yankee-financed slander. But understanding grew as health
conditions improved. And Dr. Ferrell was called from the State by the Rocke-feller
Foundation to carry the work to the world.
That work would have been enough to place him in the company of the
great physicians. But North Carolina was blessed when, as native after what
might have been time for retirement, he returned to the State of his youth to
help shape and direct Federal and State programs for hospital expansion in
North Carolina. His was a long life filled with great service. He deserves re-membrance
as one of the truly eminent men produced by North Carolina in this
century.
Editorial, Feb. 20, 1965, Raleigh New and Observer
THE HEALTH BULLETIN February, 1965
Dr. Ferrell's
Three
Public Health
Careers
Come
to an
End
Dr. John A. Ferrell, public health
pioneer, died late Wednesday night,
February 17, at Rex Hospital in Raleigh.
Funeral services were conducted at
11:30 a.m. on Friday, February 19, at
the Church of the Good Shepherd. The
Rev. James Beckwith and the Rev. Louis
Melcher officiated, and burial was at
3:30 p.m. in Elmwood Cemetery in
Charlotte.
John Atkinson Ferrell, physician and
public health administrator, was born
at Clinton, N. C, December 14, 1880,
son of James Alexander and Cornelia
(Murphy) Ferrell. His father (1832-1923)
was a merchant-farmer; his mother was
a daughter of Hanson Finla Murphy,
M.D., of Pender County, N. C.
The family has been in North Caro-lina
since colonial times, the earliest
known representative of the line being
Rev. James Alexander Ferrell, a Baptist
clergyman of Orange County, N. C, in
the eighteenth century. From him the
descent is traced through Anderson
(1804-43) and Mary (Dixon) Ferrell,
parents of James A. Ferrell, 2d.
The maternal line also runs into
colonial times, from Finla Murphy, who
came from Arrau Island, Scotland, in
1747, through Hugh Murphy of New
Hanover County, N. C, and his wife
Catherine McMillan; through Cornelius
and Catherine Murphy and Doctor Han-son
Finla and Elizabeth Anne (Simpson)
Murphy.
Dr. Ferrell was educated in the Uni-versity
of North Carolina, where he was
graduated B.S., in 1902; and M.D., in
1907. Later, in 1919, Dr. Ferrell was
graduated with the degree Dr. P.H.
(Doctor of Public Health) by Johns
Hopkins University School of Hygiene
and Public Health, the first occas.on on
which this institution conferred this de-gree
and he was the one and only
graduate that year.
For three years, (1902-05), he was
engaged in teaching and as superinten-dent
of schools in Sampson County,
N. C, and, during this time, entered
upon the study of medicine.
He began practice in Kenansville,
N. C, in 1907 and, in the same year,
was made superintendent of health of
Duplin County.
In 1909 John D. Rockefeller provided
the funds for the control in the South
of hookworm disease, which had been
found so prevalent as to become a
menace to the social and economic
progress of that area. The Rockefeller
Sanitary Commission was formed to
carry out the purpose of the benefac-tion
and Doctor Ferrell was chosen,
early in 1910, to have direction of ed-ucational
and control measures in
North Carolina with the title of As-sistant
Secretary of the State Board of
Health.
Although the disease, except among
physicians, was little known, his pione-ering
efforts resulted, during the period
1910-1913, in educating the people
throughout the State regarding the dis-ease,
its mode of spread and methods
February, 1965 THE HEALTH BULLETIN
for its prevention and cure, and in the
microscopic examination of 320,872
persons, of whom 160,689 were found
to be infected and were treated.
Upon the organization in 1913 of the
International Health Board of the Rocke-feller
Foundation, to extend throughout
the world such health work as had been
conducted by the Rockefeller Sanitary
Commission in the South and also to
embrace activities in the whole field of
public health, Dr. Ferrell was made Di-rector
for the United States. In this, he
directed the work which involves the
giving of financial aid and counsel
to official health agencies for the de-velopment
of essential branches of the
State services and also the develop-ment
of county organizations on a per-manent
basis. During his period of serv-ice,
331 full-time county organizations
were established, toward 226 of which
the Foundation contributed directly.
Dr. Ferrell, although active in the
general field of public health, featured
the strengthening of the State Health
Departments and especially the estab-lishment,
development and extension
of county health service.
In the United States, the Foundation
provided aid for training of more than
200 medical health officers to occupy
directive positions in the official health
agencies (1919-27).
As Associate Director of Internation-al
Health for the Rockefeller Founda-tion,
Dr. Ferrell directed this Founda-tion's
interests in the United States,
Canada and Mexico until 1944. From
1944 to 1946, he served as Medical
Director of the John and Mary R. Markle
Foundation.
On October 1, 1946, he began a
span of over ten years as Executive
Secretary of the North Carolina Medical
Care Commission. In this position, he
directed the use of Hill-Burton funds in
this State in the construction of 127
hospitals with an overall capacity of 6,-
567 beds, 41 nurses' residences, 3
diagnostic and treatment centers and 76
health centers— a total of 247 health
projects involving an expenditure of
$95,931,033.
He retired February 1, 1957, and he
and his wife had been living in Raleigh,
North Carolina, since that time.
His activity in professional organiza-tions
is illustrated by his membership
in the American Medical Association
(Chairman, Public Health Service, 1922-
23), the American Public Health As-sociation
(Member of Council 1 926-
29), the Southern Medical Association,
the North Carolina State Medical So-ciety
(Secretary, 1911-13), the New
Jersey State Medical Society, the Na-tional
Malaria Committee (Chairman,
1924), and the Royal Society of Public
Health.
The University of North Carolina gave
to Dr. Ferrell its Distinguished Service
Award.
He was the author of numerous
The Health Bulletin
First Published—April 1886
The official publication of the North Carolina
State Board of Health. 608 Cooper Memorial Health
Building, 225 North McDowell Street, Raleigh, N. C.
Published monthly. Second Class Postage paid at
Raleigh, N. C. Sent free upon request.
EDITORIAL BOARD
Charles M Cameron, Jr., M.D., M.P.H
Chapel Hill
John T. Hughes, D.D.S., M P H.
John C. Lumsden. B.C.H.E.
Mary Ann Farthing. MS.
Jacob Koomen. Jr., M.D . M PH.
Bryan Reep, MS.
John Andrews. B.S
Glenn A. Flinchum, B.S.
H. W. Stevens. M.D., M.P.H., Asheville
Editor— Edwin S. Preston, M.A., LL.D.
Vol. 80 February, 1965 No. 2
THE HEALTH BULLETIN February, 1965
papers and booklets on public health
subjects, among which are: "Medical In-spection
of Schools and School Chil-dren"
(1912); "Malaria of the South"
(1924); "Careers in Public Health"
(1923); "Health in Relation to Citizen-ship"
(1924); "Trend of Preventive
Medicine" (1923); "The Public Health
Nurse and County Health Service"
(1926); "The County Health Organi-zation
in Relation to Maternity and In-fancy
Work and Its Permanency" (1927);
"Survey of Provincial and State Health
Organizations"—with aid of staff—
(1927) etc.
Dr. Ferrell was married January 28,
1909 to Lucile Devereaux Withers,
daughter of Benjamin F. Withers of
Charlotte, N. C. They had one daugh-ter,
Bettie Devereaux, and two sons,
John Atkinson, Jr. and Benjamin With-ers
(deceased).
In tribute to Dr. Ferrell, Dr. J. W. R.
Norton, State Health Director, said, "He
was one of the outstanding physicians
of all time native to North Carolina. His
work here in early public health in the
control of hookworm and typhoid set
an example for the control of many
other communicable diseases. His in-ternational
service with the Rockefeller
Foundation and his service with the
John and Mary R. Markle Foundation
made him uniquely qualified to direct
the N. C. Medical Care Commission. In
that responsibility he set a pattern for
the ideal use of Hill-Burton funds in the
development of the best hospital plan-ning
and health center construction to
be found in the nation."
Death of Doctor Recalls Fight
Hookworms Once Plagued Tar Heels
by Bob Brooks
Raleigh News and Observer
Only the oldtimers remember the
campaign to stamp out hookworm dis-ease
in North Carolina.
It started in 1910, when a hardy
bunch of pioneers in public health
armed themselves with microscopes
and began probing the "stools" of
school children and adults over the
state.
By slow train, buggy and horseback
Dr. John A. Ferrell and his associates
went into every county in a hookworm
search that marked the beginning of ac-tive
public health work in this State.
Real Giant
Dr. Ferrell's death here last month
at 84 took from the State one of its real
giants in the public health field. His
direction of the hookworm control cam-paign,
as assistant secretary of the State
Board of Health, may have been his
most notable contribution.
It was a campaign which for the
first time focused the Tar Heel public's
attention on community-wide detection,
cure and prevention of communicable
diseases. Dr. Ferrell and his men con-ducted
lectures on sanitation and per-sonal
hygiene wherever they went.
The hookworm, in the early years
of this century, was a plague upon the
rural South. The small worm attaches it-self
to the lining of the upper part of
the small bowel and sucks blood from
its victim. An infected person may have
several thousand worms in him.
Rockefeller money helped in financ-ing
the State's effort to wipe out
February, 1965 THE HEALTH BULLETIN
hookworm disease. The work was di-rected
through the Rockefeller Sanitary
Commission. Dr. Ferrell was the com-mission's
State director. He had six field
directors.
Local governments were required to
provide part of the cost. Their efforts
at fighting hookworm on a matching
fund basis led to the organization of
local health departments.
In the beginning, there was some-thing
less than enthusiastic public ac-ceptance
of "the hookworm theory."
Some of the newspapers in the State re-ferred
to hookworm infection as "the
lazy disease" and "the fad."
Hookworm in the larvel stage may
enter the body through the thin skin
between the fingers and toes.
Having been given this knowledge,
some folks said Rockefeller was going
into the shoe business and the hook-worm
campaign was a scheme to get
southerners to wear shoes the year
round.
The News and Observer commented
that "many of us in the South are get-ting
tired of being exploited by ad-vertisements
that exaggerate condi-tions."
But the press and the people rallied
to the support of the campaign when
the microscopes of Dr. Ferrell and his
men began ot produce evidence of what
ailed a good many of the State's people.
Carrying specimens in tin cans, the
people stood in lines to await the at-tention
of the microscopists. The infect-ed
ones got three doses of thymol and
their health was soon restored.
The News and Observer said earlier
skepticism about the hookworm cam-paign
was not justified, and the paper
joined in the effort to publicize the
work.
Among Dr. Ferrell's field directors
was Dr. Benjamin E. Washburn, who
many years later wrote a lively account
of the hookworm campaign in North
Carolina. His booklet was published in
1960 by the Rockefeller Foundation.
Dr. Washburn was one of the most
successful field men in badgering ap-propriations
out of county boards of
commissioners. He travelled the rugged
western end of the State. In the end, he
and his colleagues squeezed money out
of 99 of the 100 county governments.
Only Ashe refused to cooperate.
"However, there were reactionaries,"
Dr. Washburn recalled. "At one place
a member objected because he thought
the money could better be expended in
buying mules for the poorhouse farm.
In another, in the county in which the
State university is located, a member
was shocked at the idea of paying a
doctor to treat worms. He contended
that a certain number of worms was
necessary to aid digestive processes. .
."
Dr. Washburn recalled that while
money was being discussed with the
Alamance County Board of Commis-sioners,
two doctors told of a case
of hookworm they had treated.
Patient's Symptoms
Among the invalid patient's symp-toms
"was eating dirt, paper and chalk,
and he was reported, as a youngster,
to have eaten half of a Bible and an
entire song book." After treatment, the
book eater became a freight train fire-man.
An "unfortunate incident" hampered
the hookworm doctors work in Swain
County. The doctor was giving his lec-ture
at a church meeting before the
preacher arrived. The preacher was de-layed
and sent word for the doctor to
keep on talking. A woman in the aud-ience
dropped dead during the hook-worm
disease lecture.
"It may be that the lecture was too
long," Dr. Washburn conceded.
Some of their findings baffled the
hookworm crews. In Haywood County,
they came upon a situation which surely
would produce a shocking rate of infec-
(Continued on page 9)
THE HEALTH BULLETIN February, 1965
Children Still
Unprotected from
Measles
With the advent of the 1965 measles
season (February through April), Sur-geon
General Luther L. Terry, of the
Public Health Service, Department of
Health, Education, and Welfare, said
recently, "only about 7 million chil-dren
have been protected by measles
vaccines, leaving about 20 million sus-ceptible
children unprotected.
"Measles is so common a childhood
disease that 90 percent of our children
get it before their fifteenth birthday.
Nevertheless, it is not the harmless
illness that most mothers seem to think
it is," Dr. Terry warned.
Although recovery is routine for
most children, about 500 children
every year die from illnesses stemming
from it. These are caused by encephali-tis
or pneumonia. About one out of
every 1,000 cases is followed by en-cephalitis.
Fifteen to 20 percent of the
encephalitis cases are left with such
after-effects as mental retardation, vis-ual
or hearing problems, or behavior
disorders, and about 10 percent of
the encephalitis cases die.
"Over 490,000 cases of measles were
reported to the Public Health Service
in 1964, and we suspect that only about
one-tenth of the actual cases were re-ported,"
Dr. Terry said. Many cases are
not even seen by a physician, he ex-plained,
because so many parents think
of it as an "innocent" disease.
"Fortunately, effective vaccines are
now available and vaccination can re-lieve
the parents of worry about
measles and its after-effects. Only a
single dose is required. In the mean-time,
any child that develops the tell-tale
red splotches should be seen by a
physician at once," Dr. Terry urged.
Water Resources
Curriculum
to be Expanded
An expanded curriculum in Water Re-sources
Development, to be inaugurated
in the Fall of 1965 at the University
of North Carolina, is to be offered
jointly by the Department of Environ-mental
Sciences and Engineering and
the Department of City and Regional
Planning. Engineers would generally
enroll in the department while plan-ners,
economists ond administrators
would enroll in the Department of City
and Regional Planning. In addition, the
resources of the Institute of Goverr-ment
on this campus would be utilized.
Dr. Maynard M. Hufschmidt, currently
Director of Research in the Harvard
University Water Program, will be join-ing
the faculty this summer to head this
curriculum.
Ample funds are available for sup-porting
graduate students in this pro-gram.
If we can provide any additional
information, please do not hesitate to
write to Dr. Daniel A. Okun, Professor
of Sanitary Engineering.
The dates for the North Carolina
ANNUAL WASTE TREATMENT PLANT
OPERATORS SCHOOL will be May 31 to
June 4. The sponsors are: North Caro-lina
Water Pollution Control Associa-tion,
North Carolina State Board of
Health, and the Institute of Government
and the Department of Environmental
Sciences and Engineering of the Uni-versity
of North Carolina at Chapel
Hill. The School will be held in Chapel
Hill. Persons desiring additional infor-mation
may contact Professor George
Barnes, Department of Environmental
Sciences and Engineering, Chapel Hill,
North Carolina 27515.
February, 1965 THE HEALTH BULLETIN
National
Rural Health
Conference
Set for
Miami Beach
Means of providing full-range health
services for the nation's 60,000,000
rural residents will be discussed at the
18th National Conference on Rural
Health March 26-27 in Miami Beach.
Among matters that will be discussed
by farm and medical leaders will be
implementation of programs for financ-ing
hospital and doctor costs among
rural residents.
W. Wyan Washburn, M.D., Boiling
Springs, N. C, chairman of the Ameri-can
Medical Association's Council on
Rural Health, which is sponsoring the
meeting, said the program was de-signed
with four goals in mind:
* To develop ways to utilize com-munity
health resources.
* To improve methods of communi-cation
in health education for rural
people.
* To emphasize the responsibility of
each family in promoting the health and
fitness of its members.
* To more fully understand the in-terdependence
of rural and urban
areas for the improvement of the health
of the people.
The keynote address for the meeting
will deal with "Health is a Way of Life."
and will be delivered by Carl S. Win-ters,
D.D., internationally known lec-turer
from Oak Park, III.
This will be followed by papers on
"Preventive Dental Care," by Joseph
Volker, D.D.S., vice president for health
affairs of the University of Alabama,
and "Safe Use of Agricultural Chemi-cals,"
by Forrest E. Myers, of the Flori-da
Agricultural Extension Service.
A feature of the March 26 afternoon
session will be the panel discussion
on "Practical Implementation of Health
Care Programs." Participants will be
Samuel P. Leinbach, M.D., Belmond,
Iowa, the vice-chairman of the AMA
council; Guithel L. Simpson, M.D.,
Greensville, Ky., chairman of the gov-ernor's
Council on Indigent Medical
Care; John L. Falls, M.D., Red Wing,
Minn.; and John Allen, M.D., Madison,
Wise, director of medical services in
the State Dept. of Public Welfare.
A series of elective discussion groups
will follow. Topics will be "Improving
Family Nutrition," "Communication to
Improve Health Practices," and "Health
of Migrant Workers."
Edward R. Annis, M.D., Miami, past
president of the AMA, will speak at a
banquet that evening.
The March 27 program will open
with a play, "To Temper the Wind,"
which deals with homemaker services.
This will be followed by a paper on
"Medical Quackery," by J. Harvey
Young, Ph.D., professor of history at
Emory University, Atlanta, Ga., and a
symposium, "Developing Community
Health Resources."
Participants will be Dr. Washburn;
Gertrude Humphreys, Morgantown, W.
Va., a state home demonstration lead-er;
Sewall Mil liken, executive director,
Public Health Federation, Cincinnati;
J. Robert Anderson, Richmond, Va., di-rector
of the state's Bureau of Health
Education,- Peter Meek, executive di-rector
of the National Health Council,
New York City; and Eugene G. Peek,
Jr., M.D., Ocala, Fla., president of the
Florida State Board of Health.
The summary speech, "The Challenge
Ahead," will be given by Roy Battles,
director, Clear Channel Broadcasting
Service, Washington, D. C.
8 THE HEALTH BULLETIN February, 1965
Robeson County
4-H #ers
Promote
"Slow Moving
Vehicle"
Signs as
Traffic Safety
Measure
Surveys show that many accidents in-volving
slow moving vehicles are
caused by the lack of adequate identi-fication
and that this often happens
when visibility is poor or at night.
Club members are planning and
working through the cooperation of
Mr. Warren Mathers, safety co-ordinator
with the Robeson County Health Depart-ment.
The purpose, need and value of the
"slow moving vehicle" signs are being
explained to all 4-H Home Demonstra-tion
and other civic clubs in an effort to
create interest and desire among people
of the county to the need to eliminate
some accidents by properly identifying
all slow moving vehicles, thus making
our highways safer.
The 4-H tractor project is being car-ried
by many of the county's farm
youth who are learning proper main-tenance
and operation of farm tractors.
Special emphasis has been placed on
the importance of using these signs.
By providing literature, giving radio
programs, writing news articles and
selling safety tags for slow moving
vehicles, many people of Robeson
County are being made more safety
conscious.
by Selwyn B. Sampson
President of Pembroke's "Eager
Eight" 4-H Club
Mr. R. H. Livermore, President of
Pates Supply Company in Pembroke,
helps 4-H'ers start their campaign by
buying signs to go on company trac-tors
and other slow moving vehicles.
The triangular signs, with bright red
center outlined in deeper red, show up
equally well during night or day. They
are designed for farm, highway and
other vehicles that travel 25 miles per
hour or less on highways.
HOOKWORM CAMPAIGN
(Continued from page 6)
tion. A survey showed the county had
few sanitary privies. Open-type privies
were placed over the many streams
and springs. The springs were the
source of drinking water in many
places.
Of the county's 15,436 population
in 1910, 3,119 persons were exam-ined
and only 200 were found to be
infected with hookworm.
The doctors didn't say so, but this
seemed to be a high tribute to the rare
qualities of Haywood's mountain air.
February, 1965 THE HEALTH BULLETIN
The Dental Care
Program of Rowan County
A Dental Care Program for the Med-ically
indigent, long felt as a need by
the Rowan County Health Department,
is now a reality as a result of the sum
of $10,500 bequeathed to the local
health agency in the will of the late
Judge R. Lee Wright of Salisbury.
Indeed, a dream has been fulfilled
as well as a need. For with the original
construction of the Health Center in
1953, a room for a dental clinic was
included, which provided such basic
essentials as water supply and sinks.
However, for want of funds for dental
equipment, the room has been used
during the intervening years as extra
office space. Now it boasts the finest
of equipment.
"For use of the aged and infirm"
were the terms of Judge Wright's will
in designating his gift to the Health
Department. As an appropriate use, the
dental care program was selected
jointly by Mrs. Sam Edwards, his niece,
George R. Uzzell, trustee of his estate,
and by the County Board of Commis-sioners.
The general objectives of the pro-gram
are to relieve pain, to promote
health, and to provide dentures for the
medically indigent.
Specifically, and by established pol-icy,
the persons being served are the
medically indigent residents of Rowan
County of over age 65 who are not
reached by other currently operating
programs, such as the Kerr-Mills Bill.
Under the latter's provisions, the Wel-fare
Department can pay only for fill-ings,
extractions, and denture repairs
(for the medically indigent of over 65).
Particular attention is being concen-trated
for the time being on that seg-ment
of the eligible group who reside
in any nursing, boarding, or rest home
financed by Rowan County taxes. To
date, all patients served have come
from the boarding homes.
The dental care is entirely free to
the eligible. Incidental expenses are
being met by the Chronic Disease Sec-tion
of the North Carolina State Board
of Health. No Rowan County funds
are being used directly in the program.
The Rowan County Dental Society
has actively supported the program and
assisted with the selection of equip-ment.
In addition they will continue as
the source of the personnel to provide
the service. At present Dr. Bruce A.
Ketner attends the patients.
The clinic is in operation one half
day a week, the current time being
Wednesday mornings.
In expressing his gratitude for this
addition to the Health Department's
services, Dr. Moffitt K. Holler, Director,
commented that, to his knowledge,
this is the only dental program of its
kind in North Carolina. Also he ob-served
that the Rowan County agency
is the only Health Department in the
State to have received a bequest of
money for a Health Department func-tion.
"We are indeed appreciative of
Judge Wright's kindness and generos-ity,"
said Dr. Holler. "And we feel that
this program will be a fitting and last-ing
tribute to a fine gentleman, who
was not only a leader in the civic,
(Continued on page 12)
(See Picture on Opposite Page)
FREE DENTAL CLINIC-The aged and in-firm
of Salisbury-Rowan are being af-forded
free dental service through the
cooperation of the State Board of
Health and funds left to the county by
the late Judge R. Lee Wright. Dr. Bruce
Ketner, currently conducting the week-ly
clinic, is shown with Mrs. Ben Bla-lock,
a patient at a local rest home.—
(Post Staff Photo by Barringer).
10 THE HEALTH BULLETIN February, 1965
February, 1965 THE HEALTH BULLETIN 11
DENTAL HEALTH
(Continued from page 10)
church, and professional activities of
Salisbury, but who also rendered dis-tinguished
service to the entire County
during his years in the North Carolina
General Assembly and Senate and as
Superior Court Judge of North Caro-lina."
Futilely, for some eleven years, the
door of the clinic has borne the label
"Dentist." Now at its entrance is a
beautiful bronze tablet with the in-scription:
This Room Equipped
in Memory of
Judge R. Lee Wright
and Wife
Sally Oakes Wright
The tablet was composed and placed
in accordance with the suggestions
of Mrs. Edwards, who had made her
home with Judge and Mrs. Wright ever
since the death of her own parents
when she was four years old.
Poliomyelitis
Vaccine Success
Demonstrated
The success of the poliomyelitis vac-cines
is clearly demonstrated by three
facts published recently by the Com-municable
Disease Center.
(1) Only 94 cases of paralytic polio-myelitis
occurred in this country dur-ing
1964; this number is less than one
fourth the number of paralytic cases
reported during 1963, which was the
previous record low year.
(2) No seasonal pattern of increased
incidence was noted during 1964.
(3) There were no outbreaks of hu-man
poliomyelitis reported anywhere
in the United States during 1964.
International Health
Meeting In Madrid
With the impulsive pressures of pop-ulation
growing every day in every
part of the world, how can people con-cerned
with health and health education
effectively contribute to immediate and
long-range action? This is one of the
central questions being asked by lead-ers
of the International Union for Health
Education as they met in Paris recently
to complete planning for the 6th Inter-national
Conference on Health and
Health Education, to be held in Madrid,
Spain, July 10-17, 1965.
The theme of this world conference
is "The health of the community and
the dynamics of development." It com-bines
concern with the various aspects
of economic and social development
with health and health education con-siderations.
Also, it gives special at-tention
to population problems and the
migration into the urban cities— an "im-plosive"
pressure in engineering terms.
A large group from the United States
is expected to participate in the Madrid
meetings, which will include technical
study groups and tours of health and
educational facilities as well as the us-ual
plenary and related meetings. The
program, reflecting the growing aware-ness
everywhere of the importance of
health as a primary factor in national
growth, is characterized by originality
and variety. It will combine the scien-tific
with the practical in its approach
to the problem of how best to create
solid bases for effective action to en-sure
better health around the globe for
all.
Write to the Editor of the Health
Bulletin if you are interested in going.
12 THE HEALTH BULLETIN February, 1965
Flim Flam Artists
Are At Work
Two flim-flam artists were at work
in Haywood County trying to conjure
money out of households through a
health ruse. According to Sheriff Jack
Arrington, who issued the warning,
the gimmick works like this:
Two white men—one about 45 and
the other about 60—knock on a per-son's
door and tell the householder
that they are from the Haywood Coun-ty
Health Department.
The artists quickly explain that a
new state law has been passed that
requires each house to be sprayed in-side
for tuberculosis germs.
While one man is in the house spray-ing
the rooms, the other man is outside
cutting the telephone wires if there are
any.
This gimmick has already worked
in the White Oak Community, according
to the sheriff.
He said an elderly man paid the
pair $140.00 to spray his house.
The sheriff's department learned
about the incident after the man's son
came home and found out what had
happened.
So the sheriff has asked all persons
to be on the look-out for the pair and
should they show up, the sheriff would
like for the owner to get as much in-formation
as possible— like color of
their car, license number, description
and such— and then refuse the service.
After refusing the service, the sheriff
said call his department or the nearest
police department.
He warned that the flim-flam artists
are "slick" enough to get by with
talking some people into a spraying
job.
People ought to only do business
with people they know and then they
would be safe," he added.
Short Course In
Accident Control
The third annual short course in Pro-gram
Development in Public Health
Accident Control has been announced
by the Department of Public Health
Administration of the University of
North Carolina School of Public Health.
The course will be held at the School
of Public Health in Chapel Hill, May 30
through June 4, 1965.
The course has been designed for:
• Administrators of state, city, or
county health departments.
• Directors, supervisors, or consul-tants
in nursing, sanitation, edu-cation,
and other allied programs
in state, city, and county health
departments.
• Accident control workers in health
departments.
Course content will include:
• Lectures on etiology, fact-finding,
and program planning.
• Problem-solving by small multi-disciplinary
groups.
For further information, write to the
Department of Administration, School of
Public Health, University of North Caro-lina
at Chapel Hill, or the Accident Pre-vention
Section, North Carolina State
Board of Health, Raleigh, North Caro-lina.
Herbert Shore, President of the Amer-ican
Association of Homes for the Aging,
has announced that AAHA's Fourth An-nual
Meeting and Conference on "The
Social Components of- Care" will be
held from Nov. 1-4, 1965 at the Disney-land
Hotel, Anaheim, California.
Highlights of the meeting will in-clude
the presentation of the annual
AAHA Award of Honor and a Legisla-tive
Breakfast Meeting on "The Aged
in The Great Society".
February, 1965 THE HEALTH BULLETIN 13
UNC Professor
Loaned to the Philippines
The World Health Organization
(WHO) has selected a University of
North Carolina professor as the public
health nursing consultant for a National
Seminar in Public Health Administration
in the Philippines in February.
Dr. Margaret L. Shetland, director of
the Public Health Nursing Teacher Prep-aration
Program at the UNC School of
Public Health and UNC School of Nurs-ing,
left in early January for her two-months
assignment.
She will be one of three consultants
for the seminar in Baguio, the sum-mer
capital of the Philippines. She will
serve with Dr. F. Main of Northern
Ireland and Dr. A. Yerby of New York
City.
Dr. Shetland was chief nursing con-sultant
with the U. S. Overseas Mission
and visiting professor of public health
nursing at the University of the Philip-pines
in Manila from late 1956 to early
1959. This will be her first visit to the
area since 1959.
The seminar in Baguio will be limited
to provincial health officers in the Phil-ippines,
equivalent to state health offi-cers
in the U. S.
The seminar staff will devote a
month to field visits and program
preparation.
Seventh Recreational Institute
The University of North Carolina,
through its Recreation Curriculum, an-nounces
that the Seventh Southern Reg-ional
Institute on Recreation with the
III and Disabled will be held in Chapel
Hill, North Carolina on April 22, 23,
and 24, 1965.
The Steering Committee for this In-stitute
met in Chapel Hill recently and
formulated a very interesting, practical
and progressive program. Detailed in-formation
regarding the Institute was
sent out in January.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
Lenox D. Baker, M.D., President Durham
John R. Bender, M.D., Vice-President Winston-Salem
Ben W. Dawsey, D.V.M Gastonia
Glenn L. Hooper, D.D.S. Dunn
Oscar S. Goodwin, M.D. Apex
D. T. Redfearn, B.S. Wadesboro
James S. Raper, M.D. Asheville
Samuel G. Koonce, Ph.G. Chadbourn
John S. Rhodes, M.D. Raleigh
EXECUTIVE STAFF
J. W. R. Norton, M.D., M.P.H. State Health Director
Jacob Koomen, Jr., M.D., M.P.H. Assistant State Health Director
J. M. Jarrett, B.S. Director, Sanitary Engineering Divisioyi
Martin P. Hines, D.V.M. , M.P.H. Director, Epidemiology Division
W. Burns Jones, M.D., M.P.H. Director, Local Health Division
E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division
Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division
Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division
James F. Donnelly, M.D. Director, Personal Health Division
14 THE HEALTH BULLETIN February, 1965
Southern
Branch, APHA
To Meet
In New Orleans
"Health Support in Man's Changing
Environment," is the theme of the 33rd
annual meeting of the Southern Branch,
American Public Health Association, to
be held in New Orleans, La., April 7, 8,
9.
Keynote speaker at the first general
session will be Dwight F. AAetzler, C.E.,
M.S., president of the American Public
Health Association. Miss Elizabeth S. Hol-ley,
president of Southern Branch, will
preside at the Wednesday and Friday
sessions.
Speaking Thursday will be Dr. Paul
Q. Peterson, Assistant Surgeon General,
Department of Health, Education and
Welfare, who will discuss "Social and
Physical Environment." Dr. Leroy E. Bur-ney,
Vice President for Health Sciences,
Temple University, will talk on "The
Professional Environment: Scientific
Knowledge, Technical Application and
Fiscal Support." The third speaker will
be Dr. Robert E. Coker, professor of
Dr. Murray Grant of Washington, D.
C. visited North Carolina early in Feb-ruary
speaking to a Seminar at the
School of Public Health in Chapel Hill.
He also spoke to the staff of the State
Board of Health and is shown in the
picture with Dr. J. W. R. Norton, State
Health Director. Dr. Grant is Health Di-rector
of the District of Columbia which
includes hospitals as well as other pub-lic
health services in a budget of some
$50 million.
public health administration, University
of North Carolina School of Public
Health. His topic is "Organization for
Support of Health." Dr. Russell E. Tea-gue,
state commissioner of health, Com-monwealth
of Kentucky, will preside
Tuesday.
Summarizing the program at the
branch meeting April 9 will be Dr.
Malcolm U. Dantzler, director for the
Charleston, S. C, county health depart-ment.
Program chairmen are Charles G. Jor-dan,
engineering division, Dade County
health department, Miami, Fla., and Dr.
Robert F. Lewis, professor and head,
division of biostatistics, Department of
Tropical Medicine and Public Health,
Tulane University, New Orleans, La.
Hosting the Southern Branch meeting
will be the Louisiana Public Health As-sociation,
Inc., Miss Edna Irl Mewhin-ney,
president.
Local arrangements committee chair-men
announced prizes for pre-registra-tion
at the Jung Hotel, convention head-quarters,
and plans for a shrimp boil,
6:30 p.m., Tuesday, April 6. In addi-tion,
there will be Dixieland bands,
sight-seeing tours, and other attractions
to be found only in America's famed
Mardi Gras city.
February, 1965 THE HEALTH BULLETIN 15
THE HEALTH BULLETIN
P. O. Box 2091
Raleigh, N. C. 27602
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If you do NOT wish to con-tinue
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and return this page to '
—
the address above. Primed by The Graphic Press, Inc., Raleigh, N. C.
DATES AND EVENTS
March 21-24 — N. C. Association of
Nursing Homes, Velvet Cloak Inn,
Raleigh.
March 22-26 — American College of
Physicians, Chicago, III.
March 26-27 — National Conference on
Rural Health, Miami Beach, Fla.
April 2-3 — Annual Meeting, N. C.
Physical Therapy Association, Win-ston-
Salem.
April 4-9 — American Industrial Health
Conference, Bal Harbour, Maine.
April 5-9 — Southern Branch, APHA,
Jung Hotel, New Orleans, La.
April 7-9 — National Council on Alco-holism,
Tulsa, Okla.
April 9-15 — American Academy of
General Practice, San Francisco, Cal.
April 12-15 — American Society for
Public Administration, Kansas City,
Mo.
April 20-22 - Eastern Branch, NCPHA,
Blockade Runner Hotel, Wrightsville
Beach.
April 22-23 — Annual Meeting, N. C.
Tuberculosis Association, Robert E.
Lee Hotel, Winston-Salem.
April 22-24 - Seventh Southern Re-gional
Institute on Recreation with
the III and Disabled, Chapel Hill.
April 23-24 - Anual Meeting, N. C.
Chapter of the American College of
Surgeons, Blockade Runner Hotel,
Wrightsville Beach.
Charlotte's Occupational Health Con-ference,
originally scheduled for March,
has been postponed and tentatively set
for October 7.
CONTENTS
John Atkinson Ferrell 1, 2, 3
Hookworms Once Plagued
Tar Heels 5
Children Still Unprotected
from Measles 7
Water Resources Curriculum
to be Expanded 7
National Rural Health Conference
Set for Miami Beach 8
Robeson County 4-H'ers
Promote Safety 9
The Dental Care Program of
Rowan County 10, 11
International Health Meeting
in Madrid 12
Poliomyelitis Vaccine Success
Demonstrated 12
Flim Flam Artists Are at Work 13
Short Course in Accident Control 13
UNC Professor Loaned to
Philippines 14
Southern Branch APHA Will Hold
Annual Meeting in New Orleans 15
16 THE HEALTH BULLETIN February, 1965
Eldercare L
APR 29 1965
Versus
DIVISION OF
Medicare H£ALTH AFFAIRS L,BRARY
Some Comments and
Comparisons
See page 2 and following
Medicare Awaits Senate Action
THE Medical Care of the Aged bill Congress is preparing for passage has a
long, curious history.
Hospitalization-nursing home portions first were proposed about fifteen
years ago. The idea had support from President Truman but failed to materialize.
Since then, the social security-financed plan consistently has been opposed by
the American Medical Association and other professional and business groups.
Until this session the bill never has been voted out of the House Ways and Means
Committee. Thus, the House never has had an opportunity to act on it. The
bill has now passed the House and is headed for several weeks debate in the
Senate.
This year, however, the climate has changed dramatically. The AMA, even in
the face of almost certain defeat, waged its strongest campaign against the ad-ministration's
Medicare bill. And the AMA pushed its own answer to health
care for the aged—Eldercare—maintaining that it offered far greater benefits than
did Medicare. This was disputed by Rep. A. Sydney Herlong, Jr., (D., Fla.), co-sponsor
of the Eldercare bill, who called AMA advertising "Misleading." For the
AMA to give the impression the bill provides complete coverage is not so, he
said. "It just makes it available for the states to provide it if they want to."
AMA's hard-hitting drive succeeded in part and perhaps not as the association
intended. The campaign has succeeded, not in building opposition to Medicare
as such, but in alerting the public to the fact that Medicare's benefits would be
limited. Most letter writers to the House committee members said Medicare would
not be enough.
Democrats on the House Ways and Means Committee realized that Medicare
alone would be a disappointment to many elderly persons.
The committee decided to work out a comprehensive medical care bill for the
aged to include payments for most drugs, medical devices, and physicians' fees.
There would be some charge to prevent overuse of benefits, and an attempt
would be made to work out a system for regaining part of the cost from wealthy
elderly persons. The system would be voluntary.
So the AMA successfully focused public attention on Medicare's deficiencies
but did not succeed in stopping the bill.
THE HEALTH BULLETIN March, 1965
How the AMA-Supported Eldercare Bill
Compares with the Administration
Sponsored Medicare Proposal
Reprinted with permission from material prepared for publication in Modern
Medicine, Copyright 1965 by Modern Medicine Publications, Inc.
ELIGIBILITY
Eldercare Bill Administration Bill
Needy persons 65 and older. Partial All persons 65 and older, regardless of
or total underwriting of health care in- need. About 16% million eligible un-surance
determined by need limits set der social security or railroad retire-by
states. AAAA estimates 11,800,000 ment plans; about 2 million others to
are eligible depending on need, not be covered through general tax funds,
counting persons covered by such pro-grams
as Old Age Assistance (OAA)
and Federal Employees Health Benefit
Plan.
CONTROL
Eldercare Bill Administration Bill
By state welfare or health agencies By Department of Health, Education,
through existing Kerr-Mills channels and Welfare through existing social se-after
acceptance by state legislature. curity channels, allocations to be kept in
separate Treasury trust fund.
COST
Eldercare Bill Administration Bill
Undetermined. One AAAA estimate of Estimated at $2 to $2.4 billion yearly,
nearly $2 ]/2 billion yearly is based on
$250 premium per person per year.
Another AAAA estimate is "between $2
and $4 billion."
March, 1965 THE HEALTH BULLETIN
FINANCING
Eldercare Bill
Through state and federal funds. Per-centage
of federal funds—52.5 to 84%
—based on a state's per capita income,
with lower income states getting a
higher proportion. Funds are used by
welfare or health departments to buy
health insurance under guaranteed re-newable
private plans. Income levels to
qualify for assistance would be deter-mined
by states, with the maximum at
least as high as the highest level now
required in the state under Kerr-Mills—
presently ranging from $1,080 to
$3,000 for individuals; $1,560 to
$3,900 for couples. Persons above
maximum would be ineligible for aid
but could purchase the same noncan-celable
policies. Those between maxi-mum
and minimum would pay part of
their premium on a sliding scale. Those
below minimum would pay nothing.
Administration Bill
Through increased social security con-tributions.
Total social security payroll
deductions, including the portion for
health care, from 1971 on, would be
10.4% (5.2% from employee; 5.2%
from employer) or 7.8% for self-em-ployed,
deductions to be made on the
first $5,600 of salary rather than the
current $4,800. Payments are made to
hospitals or other service providers or
to Blue Cross-type organizations repre-senting
hospitals. Yearly outlay of some
$250 million is anticipated from gen-eral
tax funds for those not covered by
social security or railroad retirement.
The Health Bulletin
First Published—April 1886
The official publication of the North Carolina
State Board of Health, 608 Cooper Memorial Health
Building, 225 North McDowell Street, Raleigh, N. C.
Published monthly. Second Class Postage paid at
Raleigh, N. C. Sent free upon request.
EDITORIAL BOARD
Charles M. Cameron, Jr., M.D., M.P.H.
Chapel Hill
John T. Hughes, D.D.S., M.P.H.
John C. Lumsden. B.C.H.E.
Mary Ann Farthing, M.S.
Jacob Koomen, Jr., M.D., M.P.H.
Bryan Reep, M.S.
John Andrews, B.S.
Glenn A. Flinchum, B.S.
H. W. Stevens, M.D., M.P.H., Asheville
Editor—Edwin S. Preston, M.A., LL.D.
Vol. 80 March, 1965 No. 3
THE HEALTH BULLETIN March, 1965
BENEFITS
It is impossible to compare benefits of the two bills since specific Eldercare
coverage depends on each state. However, the Herlong-Curtis bill is a modifica-tion
of the Kerr-Mills mechanism, so present Kerr-Mills practices are of interest,
even though no state is committed to follow these practices as a basis for partici-pation
under Herlong-Curtis. Presently, 40 states, 3 territories, and the District
of Columbia have operating Medical Assistance for the Aged (MAA) plans under
Kerr-Mills. According to iatest AMA figures (April 1964), 176,000 persons were
receiving assistance.
HOSPITALIZATION BENEFITS
Eldercare Bill Administration Bill
Dependent on extent of insurance pur- Sixty days per benefit period. Patient
chased by federal-state funds. pays a deductible equal to the cost of
one day national average hospital care.
Recipient is entitled to this every 180
days if there is an interval of 90 days
without hospitalization.
Kerr-Mills Experience. Of 44 states and territories offering hospitalization under
existing Kerr-Mills program (AMA report, Dec. 23, 1964), duration of paid hos-pitalization
varies from ten days per year (followed by review committee ap-proval
for possible extension) to no fixed limit. Nineteen states have no fixed
limit but leave determination of duration to the administering agency. In 15 states
with a fixed limit and no review mechanism, duration varies from twelve to
seventy days per year. Nine states have a fixed limit with reviewal for possible
extension. Benefits in one state recently starting the program are unreported.
NURSING HOME BENEFITS
Eldercare Bill Administration Bill
Dependent on extent of insurance pur- Sixty days per benefit period, no de-chased
by federal-state funds. ductible. Recipients must be transferred
from hospital to affiliated home or to
one approved by HEW.
Kerr-Mills Experience. Of 30 states and territories offering nursing home care
under existing Kerr-Mills program (AMA report, Dec. 23, 1964), duration of paid
care ranges from twenty-six days per year to no fixed limit. Eighteen states have
no fixed limit and leave determination of duration to the administering agency.
Twelve limit the stay to twenty-six to one hundred eighty days per year. Only
five states and territories require such care to be immediately preceded by hos-pitalization.
March, 1965 THE HEALTH BULLETIN 5
PHYSICIAN SERVICE BENEFITS
Eldercare Bill Administration Bill
Dependent on extent of insurance pur- None. Private insurance carriers invited
chased by federal-state funds. to provide such insurance without dan-ger
of antitrust involvement.
Kerr-Mills Experience. Of 39 states and territories offering physician payment
under existing Kerr-Mil Is program (AAAA report, Dec. 23, 1964), all have limi-tations.
Some limit the number of calls per month or quarter, some have a ceiling
on payment, and others limit the number of visits per hospitalization. Only 6 states
limit physician payment to certain conditions, such as acute, chronic, or long-term
illness. Four states do not pay physician fees under AAAA mechanism but care
for such patients without charge as staff patients.
DRUG BENEFITS
Eldercare Bill Administration Bill
Dependent on extent of insurance pur- Covers cost of drugs customarily fur-chased
by federal-state funds. nished when patients are in hospitals
or nursing homes. No coverage outside
these facilities.
Kerr-Mills Experience. Of 32 states and territories offering drug coverage under
existing Kerr-Mills program (AAAA report, Dec. 23, 1964), most are determined
by the administering agency. Four states have a cost limit: $120 a year, $150 a
year, $15 a month, $10 a prescription.
DENTAL CARE BENEFITS
Eldercare Bill Administration Bill
Dependent on extent of insurance pur- None,
chased by federal-state funds.
Kerr-Mills Experience. Of 26 states and territories offering dental care under
existing Kerr-AAills program (AAAA report, Dec. 23, 1964), 14 are restricted to cer-tain
dental conditions. One state has a $100 limit. Another limits care to patients
in hospitals or nursing homes. The rest leave determination of benefits to the
administering agency.
6 THE HEALTH BULLETIN March, 1965
OTHER BENEFITS
Eldercare Bill Administration Bill
Dependent on extent of insurance pur- Up to 240 nonphysician home health
chased by federal-state funds. care service calls per year. Diagnostic
outpatient services with deductible in
any one month of an amount equal to
half the average nationwide cost of one
day's hospital care. Services of radiol-ogists,
pathologists, physiatrists, and
anesthesiologists are included as hos-pital
services.
Kerr-Mills Experience. Under existing Kerr-Mills program (AMA report, Dec. 23,
1964), such services as home nursing, outpatient laboratory work, or diagnostic
X-ray are offered by 33 states.
Medicare Vs. Eldercare
as viewed by Consumer Reports
AFTER two decades of effort, 1965 appears to be the year for Medicare—
a Federally-administered national hospital insurance plan, financed through
Social Security contributions for persons over 65. This time the administra-tion's
Medicare bill seems assured of passage. As usual, though, the American
Medical Association has proposed a last-gasp substitute. A comparion of the two
proposals is instructive.
The Medicare bill may of course be altered in the legislative process, but its
four basic provisions are not likely to be changed significantly. They can be out-lined
briefly. For those over 65, Medicare would:
• Pay the full costs of up to 60 days of hospitalization (in ward or semi-private
accommodations), minus a first-day deductible, for each benefit period (which
begins on the first day of hospitalization and ends whenever the patient has ac-cumulated
90 days out of the hospital within a period of 180 days).
• Provide for an additional 60 days of post-hospital care for each illness in a
convalescent or rehabilitation center operating under an agreement with a hos-pital
(not an ordinary, custodial-care nursing home).
• Pay for up to 240 home nursing visits a year under medical supervision, in
programs organized by nonprofit voluntary or public agencies.
• Provide payment for hospital outpatient diagnostic services and tests, minus a
deductible that would exclude routine low-cost laboratory or other diagnostic
procedures.
March, 1965 THE HEALTH BULLETIN
These provisions would be financed by an increase in the Social Security with-holding
tax. Ultimately, a citizen would contribute (to a special, separate health
care trust fund within the Social Security system) 0.45% of his earnings up to
$5600, and his employer would contribute an equal amount. Special provision
would be made for those now over 65 who are not covered by Social Security
through the Government's general fund.
The Medicare program gives the citizen free choice of physician and hospi-tal.
It does not pay the costs of doctor bills, out-of-hospital drugs, prolonged or
catrastrophic illness requiring long, continuous hospitalization, or extended custo-dial
care in nursing homes.
CU's medical consultants believe that this is, by and large, a sound basic
package. The 60-day provision would encompass all but about 5% of the usual
hospital stays of older persons, and the extended-care proposal would both re-lieve
the pressure on general hospital beds and spur the construction of badly-needed
convalescent and rehabilitation facilities in many communities. Services
of this kind are essential in many illnesses following their acute stage and prior
to the time a patient can return to his home or transfer (if necessary) to a custodial
institution.
The provision for organized home nursing services has obvious value: such
services often preclude the need for hospitalization and permit earlier discharge
from hospital or convalescent center. Out-patient diagnostic services also are
capable of averting many costly hospitalizations by encouraging the early de-tection
and treatment of disease—at a time when it may be cured or controlled
by relatively simple short-term procedures.
Since the heaviest health cost of the elderly is hospitalization, the Medicare
coverage could make it financially possible for the first time for many citizens to
purchase voluntary insurance (of the Blue Shield type) to cover physicians' bills
and other supplementary costs.
The AMA substitute for Medicare at first glance seems invitingly compre-hensive.
(It is, in fact, a resurrection of proposals made during the Eisenhower
administration that the AMA bitterly opposed at the time, and again just a few
months ago at its House of Delegates meeting. The AMA now refers to its "new"
proposal as a "redefinition" of policy.) The AMA substitute simply proposes the
use of state and Federal funds to buy Blue Cross-Blue Shield or commercial health
insurance for indigent persons over 65—it does not say how the funds would
be raised, in the absence of a Social Security tax.
The proposal does say, however, that a means test would be required to
determine the eligible poor, with the states using state and Federal money to
pay all, some, or none of the insurance premium cost, depending on the citizen's
qualification under the means test. Means tests are—moral considerations aside—
enormously expensive and difficult to administer. Furthermore, the program
would be administered by the states, raising the possibility that there would
be 50 different kinds of governmental machinery, eligibility standards, and pay-ment
procedures. (Under some state rules setting eligibility for help under the
current Kerr-Mills law, ownership of property or even ability of one's children to
pay can make an old person ineligible.)
The subsidized insurance would pay for physicians' and surgeons' bills and
drug costs as well as hospital bills, and an AMA statement asserts that this would
be "comprehensive health care" and not "limited to hospital and nursing home
8 THE HEALTH BULLETIN March, 1965
care representing only a fraction of the cost of sickness." As CU has pointed out,
however, this "fraction" covers the heaviest, the most financially crippling share
of the burden. Furthermore, since the AMA has not spelled out specifically what
the private insurance would cover (and in existing voluntary insurance policies,
cash benefits, days of coverage, and other provisions vary widely from plan to
plan and from area to area), it is difficult to tell how "comprehensive" the pro-tection
of the AMA's proposal would be.
The current Medicare proposal, obviously, will not solve every aspect of the
nation's health problems, even for those over 65. It does not and cannot guaran-tee
good medical care to its beneficiaries, and it pays relatively little attention to
the quality of the services it pays for (though the bill does contain a provision
for periodic review, by the medical staffs of participating hospitals, of the neces-sity
for hospitalization, length of stay, and other such features). However, it is a
significant beginning.
Reprinted with permission from Consumer Reports (March, 1965). Copyright 1965
by Consumers Union of U. S., Inc.
Determining Medical Indigency
Reprinted by permission from the American Journal of Public Health,
copyright 1964 and 1965 by the American Public Health Association
BASIC in the provisions of Eldercare, sponsored by the American Medical
Association, is the principle that the health care shall be made available
only to persons qualifying as being medically indigent. Determination of
medical indigency is admittedly a difficult and costly process.
The National Council on Aging presented a report on this subject at the 1964
meeting of the National Conference on Social Welfare. The report, entitled, "Prin-ciples
and Criteria for Determining Medical Indigency", was published in full in
the October, 1964 issue of the American Journal of Public Health.
The principles set forth in this report of the National Council on Aging are
reprinted here on the following pages through the courtesy of the American Jour-nal
of Public Health, together with the comments of Milton I. Roemer, M.D., Pro-fessor
of Public Health at the University of California, School of Public Health,
in Los Angeles. Dr. Roemer was invited by the National Council on Aging to be
one of the two discussants of this report at the National Council on Social Welfare
and his comments carried in the March, 1965, issue of that publication.
March, 1965 THE HEALTH BULLETIN 9
These principles are goals that will
not be attained quickly; in many in-stances
they call for changes in legisla-tion
and policies and for training of
personnel. Some changes could be
made by revising administrative pro-cedure
and regulations. Others will de-pend
upon the public's conviction of
the need to expend the necessary
funds.
The committee believes that carrying
out the recommended principles will re-sult
in conservation of human resources
and in prevention of suffering now
caused when handicapping policies and
unsound practices obtain in the de-termination
of medical indigency.
Principles for the Determination of
Medical Indigency
1. People who cannot afford medical
care are entitled to it as a human right
and as a sensible means of conserving
human resources.
2. Neither race, creed, color, country
of national origin, citizenship, nor
length of residence should be criteria
for determining medical indigency.
Mental retardation, advanced age, or
previous history of mental illness should
not of themselves prejudice financial
eligibility for needed medical care.
3. Determination of the amount and
kind of medical care needed is a judg-ment
of the health professions. The de-cision
as to eligibility for aid in meet-ing
this need should be a combined
medical and social judgment, with due
consideration given to implications of
the illness or handicap for the family,
estimated cost of care, relationship of
the medical need to the patient's re-sources,
medical or health needs of
other members of the family, and spe-cial
family needs.
4. Persons and families having in-comes
and resources at or below speci-fied
levels should be eligible for pay-ment
for medical care automatically.
Only for persons and families with in-comes
above the specified levels need
further inquiry be made.
5. Criteria applied in determining
financial eligibility should be objective-ly
established and should not result in
family insolvency.
6. Income levels for use in the de-termination
of medical indigency should
represent a reasonable level of living.
7. In order to provide for his med-ical
care, no claim or lien should be
taken on a patient's home and furnish-ings
or on equipment essential for earn-ing
a living.
8. No arbitrary income ceiling should
be set beyond which no patient can be
judged medically indigent.
9. Legal or administrative policies
specifying that relatives assume finan-cial
responsibility are undesirable, ex-cept
in case of the patient's spouse or
the parents of a dependent child.
10. Community health and welfare
agencies that provide or subsidize med-ical
and dental care should collaborate
in developing general policies as a
framework within which each deter-mines
medical indigency.
11. When several agencies are deal-ing
with a patient who can partially
pay for his medical care there should
be joint agreement on the respective
responsibilities and shares in the total
patient funds available.
12. The agency that provides the sub-sidy
for medical care should determine
medical indigency.
13. General policies should be ad-ministered
flexibly in relation to indi-vidual
circumstances and problems.
14. Qualifying conditions of eligibil-ity
should conform to social values of
dignity, privacy, confidentiality, indi-vidual
responsibility, and family unity.
These should be taken into account both
in regulations established and in proc-essing
applications.
10 THE HEALTH BULLETIN March, 1965
15. A public agency or institution
rendering or subsidizing medical care
has the obligation to consider an ap-plication
from any person within the
group it serves and to take action on an
appeal of the decision.
These principles are fundamental to
good administration of the determina-tion
of medical indigency. Extraordi-nary
situations may sometimes arise
when one of the principles of a more
practical nature will need flexible ad-ministration
on an individual basis.
Present-day experience indicates that
such situations rarely occur.
Dr. Roemer's Letter to
the Editor of the
American Journal of
Public Health
To the Editor:
The report of the National Council on
Aging entitled "Principles and Criteria
for Determining Medical Indigency"
and published in the October, 1964,
issue of the Journal calls for comment.
This important document was given
its first public presentation at the Na-tional
Conference on Social Welfare, as-sembled
in Los Angeles on May 26,
1964. It happens that I was invited by
the National Council on Aging to be
one of the two discussants of the report,
as it was presented by Mrs. Edith Alt.
My remarks and those of the other dis-cussant
(Mr. Carel Mulder of the Cali-fornia
State Department of Social Wel-fare),
however, have not been publish-ed.
There are some very serious social
policy implications to a formal crystal-lization
of the whole concept of "med-ical
indigency" that may be overlooked,
while—with the best of intentions—one
is trying to improve medical care for
the poor. The fundamental question is
"how should medical care for the poor
be financed?" rather than "how should
medical indigency be determined?" I
tried to explore these conceptual prob-lems
in my commentary on the report,
which was as follows:
There can be no doubt that this report
on principles for determining medical
indigency, produced by the National
Council on the Aging and summarized
so very well by Mrs. Alt, is a positive
contribution to the tasks of administra-tion
of medical care in the United States
today. A variety of governmental and
voluntary programs must now make
such determinations, and effectuation of
the principles advocated in this report
would surely facilitate proper medical
care and protect human dignity more
than has often been the reality in the
past. The principles proposed on key
issues like property liens, residency re-quirements,
relative's responsibility,
court commitments, and so forth, would
move us significantly further along the
path from tribalism to social responsi-bility.
Nevertheless, as I read through this
fine report—exemplary in its careful
workmanship and presentation— I be-came
more and more unhappy about it.
My disturbance was not for what it
said, but for what it did not say. I am
aware that the distinguished committee,
representing as it did organizations of
diverse sociopolitical philosophies, set
itself a specific task, to define "criteria
of medical indigency," from which it
deliberately did not deviate. Yet it is
the very posing of this task that I
would like to comment on.
Perhaps, as the "Foreword" of the
report states, the project was 25 years
March, 1965 THE HEALTH BULLETIN 11
overdue, but why was it undertaken
just now? Surely it is not unrelated to
the fact that in 1960 we acquired in the
United States the first federal public
assistance legislation in which the con-cept
of "medical indigency" has been
embodied as a statutory basis for aid.
This emerged from a national debate
on health insurance for all of the aged.
Crippled children's programs, Veterans
Administration medical services, and
certain other programs, it is true, pro-vide
federal funds for specific bene-ficiaries
who are, in fact, "medically in-digent,"
and purely local or state funds
have long been used for the "med-ically
indigent" under the "general as-sistance"
heading. But the Kerr-Mil Is
program on Medical Assistance to the
Aged was the first amendment to the
basic structure of welfare services for
the needy in which federal support for
this concept became crystallized into
law.
The MAA amendments, of course, ap-ply
only to persons past 65 years of
age, but it is perfectly clear that certain
groups would like to see the concept
extended to all age levels, and indeed
the NCOA Report specifically empha-sizes
this wider applicability. The basic
premise, therefore, is that the total pop-ulation
may, for the purpose of financ-ing
medical care, be divided into sev-eral
more or less distinct classes. Based
on the recommendations in the report,
these would be essentially as follows
(excuse my backward numbering which
has its reasons):
5. The fully indigent—persons who
need financial assistance for their basic
living needs, as well as for all their
medical care, in order to survive.
4. The wholly medically indigent-persons
of such low income that, while
they can eke out a subsistence life with
respect to food, clothing, and shelter,
need financial assistance for the medical
care of any illness, if it is to be of
adequate quality.
3. The partially medically indigent-persons
whose income and family re-sponsibilities
permit them to meet ordi-nary
living requirements as well as the
costs of minor illness, but who require
financial assistance for the costlier med-ical
care of serious or prolonged ill-ness.
2. The insured self-reliant— persons
whose income and responsibilities per-mit
them to meet ordinary living re-quirements
as well as the cost of minor
illness, and who are protected by some
form of medical care insurance which
covers the costs of major or prolonged
(but not too prolonged) illness.
1. The fully self-reliant — persons
who, with or without insurance, can
meet without assistance all their living
costs as well as all costs of medical
care for any illness, minor or major.
Even this subdivision of the Amer-ican
population into five classes, intri-cate
as it may seem, is really an over-simplification.
As social workers know,
there are various subclasses of fully
indigent under Class 5. Under the prin-cipal
"medically indigent" groups,
Classes 4 and 3, there are numerous
shadings and subdivisions depending
on the type of illness, the availability of
organized medical facilities, the attrib-utes
of the family at the time and
place, and so forth. Under Class 2, the
combinations and ramifications of in-surance
coverage and benefits would
lead to another dozen or so subclasses,
if the scene were fully analyzed. And
even under Class 1, the definition
would have to lead to numerous sub-classes,
unless it were so strictly applied
that only a handful of oil magnates or
movie stars ended up in it.
Yet, this is the kind of demographic
gymnastics that we are led to by the
conceptual premises of this report on
"medical indigency." There are two di-mensions
to medical indigency, as the
reports brings out so well, (a) the per-son
and (b) the medical requirements,
12 THE HEALTH BULLETIN March, 1965
and the range of variability along both
these dimensions is very long, indeed.
It is hard enough to make a sound judg-ment
along the first dimension, but to
do it along the second, and then along
both in combination—if this is done
scientifically and objectively— is an enor-mous
administrative task. I was particu-larly
struck by the somewhat cavalier
brevity of the report on the need for
"information and adequate interpreta-tion
on . . . anticipated duration and
estimated cost of medical care" for a pa-tient.
Prognosis is tough enough for the
soundest clinician, and attaching price
tags to it as well calls for the com-bined
wisdom of a William Osier and
a John M. Keynes.
Mrs. Alt cogently points out that 42
per cent of American families—with in-comes
in the $3,000 to $7,500 range-are
vulnerable to medical indigency; she
believes that "a majority of these (fami-lies)
will fall at some time within the
medically indigent group." I suspect that
this is a conservative estimate, but the
administrative task is to identify which
individual families in this "majority"
and which dates within this "time"
yield an affirmative decision on medical
indigency.
Small wonder that all these complexi-ties
and uncertainties about the imple-mentation
of the concept of medical in-digency
have led most industrialized na-tions
of the world to give it up com-pletely.
In its place, they have substi-tuted
systems of social insurance for
medical care and networks of public
clinics and hospitals for virtually all who
come to their doors. Almost all countries
have done this for the total population
with respect to the costliest element in
health service—care in a general hos-pital—
including most recently our Ca-nadian
neighbor to the north.
The objection to the "medical in-digency"
concept lies not only in its
enormous administrative complexity—
which must of course be translated into
the costs and time and efforts of skilled
professional personnel. These efforts
could be far better spent on social case-work
and other positive services. More
important are its implications for the
kind of medical care that people would
and do receive in a class-structured sys-tem.
A class-categorization of people for
entitlement to medical care—whether
into five levels as implied by this report
or into ten levels or into two levels-leads
inevitably into class-levels of med-ical
service. The evidence for this is
around us everywhere��� in the crowded
public clinic compared with the private
medical office, in the public ward surg-ery
by the assistant resident versus
the private room surgery by the board-certified
specialist, in the dental ex-traction
versus the root-canal therapy.
This, of course, was certainly not the
intention of the dedicated people who
have produced the report that Mrs.
Alt has summarized. But there is world-wide
evidence that for reasons that are
at once economic, political, and atti-tudinal
this is where it leads us.
We have been moving forward in
America with a democratization of med-ical
care through the vast growth of
health insurance. We still have a long
way to go, but progress is being made
every day. Here in California, there is
serious talk of emerging from our 19th
century county hospital system for the
separate care of the poor. The Social
Security Act pension system was a mile-stone
in helping to achieve economic in-dependence
and dignity for nearly all
aged persons, without a means test. I
hope we do not now encourage a move-ment
backward, along the path laid out
by the Kerr-Mills amendment, into a
legally frozen class-ridden pattern for
an American's entitlement to general
medical care.
Milton I. Roemer, M. D.
Professor of Public Health, University
of California School of Public Health,
Los Angeles, Calif.
March, 1965 THE HEALTH BULLETIN 13
IMMUNIZATIONS START
AT HOME
Members of the Staff of the State
Board of Health took their own medi-cine
Monday morning when they lined
up for needed immunizations as the
State Board launched a 17 month State-wide
program urging early immuniza-tion
especially of the new-born and of
pre-school age children. Shown in the
picture is Mollie Murray, who operates
the Snack Bar in the Cooper Memorial
Health Building, receiving one of her
shots from Mrs. Ruth L. Edwards, pub-lic
health nurse of the Wake County
Health Department. Looking on, from
the left, are Dr. Jacob Koomen, Jr., As-sistant
State Health Director; Dr. Ronald
H. Levine, field epidemiologist of the
State Board; and Dr. William E. Bellamy,
Jr., of the Wake County Medical So-ciety.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
Lenox D. Baker, M.D., President Durham
John R. Bender, M.D., Vice-President Winston-Salem
Ben W. Dawsey, D.V.M Gastonia
Glenn L. Hooper, D.D.S. Dunn
Oscar S. Goodwin, M.D. Apex
D. T. Redfearn, B.S. Wadesboro
James S. Raper, M.D. Asheville
Samuel G. Koonce, Ph.G. Chadbourn
John S. Rhodes, M.D. Raleigh
EXECUTIVE STAFF
J. W. R. Norton, M.D., M.P.H. State Health Director
Jacob Koomen, Jr., M.D., M.P.H. Assistant State Health Director
J. M. Jarrett, B.S. Director, Sanitary Engineering Division
Martin P. Hines, D.V.M., M.P.H. Director, Epidemiology Division
W. Burns Jones, M.D., M.P.H. Director, Local Health Division
E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division
Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division
Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division
James F. Donnelly, M.D. Director, Personal Health Division
14 THE HEALTH BULLETIN March, 1965
No Certainty In Eldercare
The problem of the elderly ill who can not afford adequate medical care
has been with us for a long time, but the latest Louis Harris survey puts it in
clear perspective: It is the number one domestic issue in the country today. More
than 32 per cent of all American families have an elderly member in need of
special medical attention, and less than half of them can afford it, the Harris
survey found.
That helps explain President Johnson's determination to enact the Medicare plan
that would provide guaranteed hospital care for the elderly under Social Security.
It is the high cost of hospital services which overwhelms the meager financial
resources of so many old people.
The Medicare plan is under attack by the American Medical Association which
proposes an alternative it labels as the "Eldercare" plan. This alternative would,
the association says, authorize medical and surgical payments as well as pay-ments
for hospital bills. It would indeed authorize a wide range of health care
services. But it would guarantee very little.
Under Eldercare, it would be up to the states to put up matching funds and
decide the level of medical care provided. This could be as little as one day in
a hospital and one visit annually from a doctor.
Some state legislatures would enact a niggardly program because of dominant
conservative control in state government. Many more, such as North Carolina,
would do the same because they can afford no better. This is not the only
grave fault of the Eldercare plan, but it is one of the bigger ones not even hinted
at in the glowing AMA sales pitch.
In contrast, the elderly would know what they were getting under Medicare
and they could depend on it: Sixty days of post-hospital care, 240 days of home-health
visits, and out-patient diagnostic service every year.
Editorial in Raleigh (N. C.) News and Observer, March 2, 1965
March, 1965 THE HEALTH BULLETIN 15
THE HEALTH BULLETIN
P. O. Box 2091
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Printed by The Graphic Press, Inc., Raleigh, N. C.
DATES AND EVENTS
April 20-22-Eastern Branch, NCPHA,
Blockade Runner Hotel, Wrightsville,
Beach.
April 22-23-Annual Meeting, N. C.
Tuberculosis Association, Robert E.
Lee Hotel, Winston-Salem.
April 22-24—Seventh Southern Regional
Institute on Recreation with the III
and Disabled, Chapel Hill.
April 23-24-Annual Meeting, N. C.
Chapter of the American College of
Surgeons, Blockade Runner Hotel,
Wrightsville Beach.
April 23-24-Annual Meeting, N. C.
Society of X-Ray Technicians, Ashe-ville.
April 25-28—Southeastern Psychiatric
Association, Annual Meeting, Pine
Needles Lodge, Southern Pines.
April 27-29-N. C. PTA Convention,
Jack Tar Hotel, Durham.
April 28-May 1—American College
Health Association, Miami Beach, Fla.
April 29-30— President's Committee on
Employment of the Handicapped,
Washington, D. C.
May 1-5—Medical Society of the State
of N. C, Queen Charlotte Hotel,
Charlotte.
May 1-7-National Mental Health Week.
May 2-8-N. C. Special Week on Ag-ing.
May 3-7— National League for Nursing
(Biennial Convention), Civic Auditor-ium,
San Francisco, Calif.
May 4-5—Association of American Phy-sicians,
Atlantic City, N. J.
May 5-6—Annual Meeting, N. C. Die-tetic
Association, Jack Tar Hotel,
Durham.
May 6-8—American Pediatric Society,
Philadelphia, Penn.
May 7—Annual Conference of N. C.
Rural Safety Council, YMCA, Raleigh.
May 9-15-National Hospital Week.
May 1 0-1 2—American National Red
Cross, Detroit, Mich.
CONTENTS
Medicare Awaits Senate Action 2
How the AMA Supported Eldercare
Bill Compares with the Admin-istration
Sponsored Medicare
Proposal 3
Medicare Vs. Eldercare 7
Determining Medical Indigency 9
Principles proposed by National
Council on the Aging
Comments by Dr. Milton I.
Roemer
Immunizations Start at Home 14
No Certainty in Eldercare 15
16 THE HEALTH BULLETIN March, 1965
The Officio! Publication Of Carolina State Board of Health
V, %Q*r
flPZU i9bf
in
' .-'"
«'.
llH
A promising theory of modern cancer research holds that certain indi-viduals
(represented by the shaded fiingerprints on our cover) share
symptoms indicative of a high cancer risk. If this proves true, doctors
will be able to identify, among a typical group like the one below,
persons who are most likely to develop cancer and who therefore need
more frequent and more specialized treatment. For more, see page 3.
THE HEALTH BULLETIN April, 1965
"I have a theory that virtually all agents which can produce cancer, produce other
types of changes first . . . The problem has been to launch an all-out search for
such symptoms, which is just what we're doing in the cancer prevention study."
"In a fundamental sense, all health is one nowadays. The battle against cancer in-evitably
involves fresh insights into what it takes to live and be healthy in a
shrinking and increasingly complex world. Evolution has not adapted us to many
of the things we are introducing into our environment, tensions as well as
drugs . . ."
AVisit With Cuyler Hammond
By JOHN E. PFEIFFER
We call on the head of the American Cancer Society's
Statistical Research Station who tells how the disease is
being studied with statistics, surveys and data processing.
Reprinted by permission from THINK
Magazine, Copyright 1965 by International
Business Machines Corporation.
IN the last analysis, all medical pro-gress
can be traced to clinical find-ings,
to the recognition of significant
differences between people who come
down with a particular disease and
people who don't. A classical example
is the 18th century "superstition" that
April, 1965 THE HEALTH BULLETIN
milkmaids were protected from small-pox
by previous infections of a related
but far milder disease, cowpox, a notion
that led to the development of success-ful
vaccines. Today, as in times past,
advances continue to come from shrewd
observations, which are often based on
highly sophisticated methods of gather-ing
data and making inferences.
Such methods are being used in the
increasingly intensive fight against can-cer,
in many ways the most challenging
medical problem of our times. For
more than forty years, the leader in this
fight has been the American Cancer
Society, Inc., which, in addition to sup-porting
laboratory and hospital research,
has launched large-scale surveys de-signed
to provide new knowledge
about the causes and prevention of
cancer—an activity directed by E. Cuyler
Hammond, head of the Society's Sta-tistical
Research Station and an inter-nationally
noted master of the subtle
art of evaluating facts.
A Yale graduate and former indus-trial
health investigator at the National
Institutes of Health, Hammond is most
widely known for findings on smok-ing
and health. But his interests ex-tend
beyond the problem of lung can-cer,
as I learned when I spoke with
him recently in New York, where Am-erican
Cancer Society headquarters are
located.
Hammond is a quietly intense, lean-faced
man in his early 50's. He chooses
his words carefully before responding
to a question and then starts talking
at a rapid rate, looking at you with
sharp eyes and usually punctuating
the end of his answers with a smile.
Dedicated to the full-time job of an-alyzing
ideas that can be expressed pre-cisely
and tested (he works most nights
and every weekend), he approaches
cancer problems from a broad point of
view.
"The greatest achievement of the last
hundred years," he told me, lighting up
his pipe, "isn't the hydrogen bomb or
space travel or more washing machines.
These things and a good deal more are
all by-products of a more basic devel-opment,
the spectacular improvement
in health which has given us time for
longer periods of education and for
longer productive lives. If you look
back at the records for this country
you can see that the big killers were,
as they still are in some parts of the
world, infectious and parasitic diseases
such as malaria, smallpox and tuber-culosis.
The huge decline in death rates
has been above all a result of preven-tive
medicine, slum clearance and san-itation
and vaccines and other public
health measures.
"Our biggest problems today are
heart disease, cancer and other degen-erative
illnesses which generally take
years or decades to develop and tend to
The Health Bulletin
First Published—April 1886
The official publication of the North Carolina
State Board of Health, 608 Cooper Memorial Health
Building, 225 North McDowell Street, Raleigh, N. C.
Published monthly. Second Class Postage paid at
Raleigh, N. C. Sent free upon request.
EDITORIAL BOARD
Charles M. Cameron, Jr., M.D., M.P.H.
Chapel Hill
John T. Hughes, D.D.S., M.P.H.
John C. Lumsden, B.C.H.E.
Mary Ann Farthing, M.S.
Jacob Koomen, Jr., M.D., M.P.H.
Bryan Reep, M.S.
John Andrews, B.S.
Glenn A. Flinchum,
H. W. Stevens, M.D.
B.S.
M.P.H., ASHEVILLE
Editor—Edwin S. Preston, M.A., LL.D.
Vol. 80 April, 1965 No. 4
THE HEALTH BULLETIN April, 1965
•';:->
"The past thirty years or so have seen
a notable increase in cure rates, one
major reason being the American Cancer
Society's public education program."
strike later in life—and here again a
central goal, together with improved
treatments and cures, is prevention. As
in the past, we must draw heavily on
the techniques of epidemiology, the
study of circumstances under which dis-ease
occurs in the human population.
We want to discover critical causative
factors, factors which increase the prob-ability
of sickness and death."
Accent on Statistics
Hammond is well aware of the dif-ficulties
of such research. For relatively
minor ailments like athlete's foot, new
treatments may be tested on patients
without running serious risks. But when
it comes to major diseases, investigators
can't perform extensive experiments on
human beings. Furthermore, animal
experiments conducted under strictly
controlled laboratory conditions have
only a limited, remote bearing on the
uncontrolled and complex conditions
of everday life. So the accent is neces-sarily
on statistics based upon obser-vations
rather than experiments. Since
it is quite possible to draw invalid con-clusions
from valid facts, I asked about
the pitfalls of the statistical approach.
"Let me give you an example," Ham-mond
replied, as he paused to relight
his pipe. "During World War II, I was
stationed at the Air Force School of
Aviation Medicine in Texas, and we
were all very much concerned with the
extremely high accident rate among
pilots undergoing training. Some psy-chiatrists
had the theory that most of
the accidents were occurring among
'accident-prone' men, individuals psy-chologically
predisposed to carelessness
resulting in accidents. So, pilots recently
involved in aircraft accidents were ask-ed
detailed questions about their child-hood
accidents—and they recalled a
great many falls, broken bones and
other mishaps. On the other hand, pilots
who had never been involved in an
aircraft accident reported very few
childhood accidents. Apparently the ac-cident-
prone theory had been confirm-ed.
"I was immediately suspicious, how-ever.
For one thing, the results were
too darned good. Hardly anything seem-ed
to have happened during the child-hoods
of pilots with no training ac-cidents,
while everything seemed to
have happened to less fortunate pilots.
I suspected that there might have been
some bias in response, because an air-craft
accident can be a terribly shaking
experience. A man may be in such a
state of confusion and guilt afterwards
that you could probably get him to
'confess' to beating his own mother.
This is always one of the problems
with the 'retrospective' or historic sur-vey,
that is, a survey involving people
April, 1965 THE HEALTH BULLETIN
who are already victims of the condition
you are trying to learn about. Emo-tionally
upset people cannot be count-ed
on to give unbiased reports.
"So we decided to do a prospective
or follow-up survey, questioning about
twenty-five hundred consecutive pilots-to-
be before they went into training.
Then we put the records away in a
safe. More than a year later, we went
back and compared the records of pilots
who had been in accidents during their
first year of training and pilots who
hadn't. As far as the number and
severity of childhood mishaps were
concerned, absolutely no significant dif-ference
existed between the two
groups. In other words, it was useless
to question applicants about their child-hood
accidents as a means of eliminat-ing
men most likely to be involved in
an aircraft accident.
"This experience was very much on
my mind 15 years ago, when we knew
much less about smoking and cancer,
and most of our statistics were based
on retrospective surveys. But many of
us, aware of the possibility of a bias
factor and other problems, were frankly
skeptical."
Hammond explained that the next
step, as in the Air Force study, was
an ambitious prospective survey—the
first of its kind in this country and a
task which only an institution like the
American Cancer Society could under-take.
In 1951, it mobilized more than
22,000 volunteers, many of them form-er
cancer patients, to obtain complete
information about the smoking habits of
some 188,000 presumably healthy men
between the ages of 50 and 70. In or-der
to avoid possible bias on the part
of the volunteers, the men were not in-terviewed;
they were simply asked to
fill out questionnaires. Having built up
considerable good will among physi-cians
and hospital authorities over the
years, the Society had ready access to
medical details on those who died of
cancer. When the time came for follow-up
studies two years later, 1 1,870 men
had died, 2,249 of them from cancer.
Analysis of the records confirmed
retrospective studies in showing a de-finite
association between cigarette
smoking and cancer. "Just as impor-tant,"
says Hammond, "we had shown
that follow-up studies were feasible on
a very large scale, if you have a good
organization behind you and plenty
of volunteers. If we'd had to pay them
what they were worth, it would have
cost us several million dollars.
"Soon we began thinking about our
ultimate objective: means of preventing
many if not all types of cancer. In or-der
to obtain information directed to-ward
this goal, an even more extensive
epidemiological study was required, one
which would deal with other factors as
well as smoking, other forms of cancer,
and women as well as men. We worked
out a most thorough questionnaire.
Among other things it included occupa-tion,
details of present health status,
education, eating and drinking habits,
hours of sleep per night, and so on.
The survey started more than five years
ago, with 68,000 volunteers this time.
The plan was to interview some million
people aged 30 or older, and to follow
up every one of them six times at an-nual
intervals.
"Right now we're finishing our fifth
follow-up and are beginning to analyze
the data. We already have about three
hundred bits of information about each
person, so you can appreciate the mag-nitude
of our task and why we've had
to develop special ways of using elec-tronic
computers. In our work spectac-ular
calculating speeds aren't nearly as
important as effective man-machine
communications. Since I like to plan as
I go, what matters to me is how long it
takes from the time I get an idea—
a
hunch, if you will—to the time I see an
THE HEALTH BULLETIN April, 1965
actual printed table. Then I want to be
able to modify my idea, or try another
one in a reasonable time, and get a
quick answer again. It's something like
having a conversation with the comput-er."
What are the objectives of the cur-rent
survey?
"Part of the story is indicated in the
official name, 'Cancer Prevention Study.'
The past thirty years or so have seen a
notable increase in cure rates, one
major reason being the American Can-cer
Society's public education program.
The emphasis on danger signals, per-sisting
symptoms such as hoarseness or
unhealing sores which may result from
early stages of the disease, has certain-ly
helped alert people to the impor-tance
of prompt treatment. But we want
to do better than that, to carry the
offensive one step further.
"What we would like to do is dis-cover
complaints that appear before
the disease process has a chance to
establish itself. I have a theory that
virtually all agents which can produce
cancer, produce other types of changes
first. For example, lung cancer is al-ways
preceded by an appreciable in-crease
in the number of cell layers in
the bronchial tubes, more mucus and
other effects which very probably de-velop
years or decades before cancer.
It also happens that such tissue changes
within the body may be associated with
symptoms like coughing and shortness
of breath.
All-Out Search
"The problem hbs been to launch an
all-out search for such symptoms, which
is just what we're doing in the cancer
prevention study. We are looking for
signs on the broadest possible basis
because, as things stand now, we don't
know exactly where to look. We have
asked our million persons how much
exercise they get (none, slight, mod-erate,
heavy), which of six medicines
they use (never, seldom, often), wheth-er
they experience various degrees of
some two dozen physical complaints,
and a host of other questions. We hope
to discover that certain of these factors,
"In a fundamental sense, all health is
one nowadays. The battle against can-cer
inevitably involves fresh insights in-to
what it takes to live and be healthy
in a shrinking and increasingly complex
world."
April, 1965 THE HEALTH BULLETIN
or "clusters of factors, may serve as
warnings of impending cancers."
To Save More Lives
Nothing of this scope has ever been
t|ied before, and Hammond pointed out
that it is still much too early to predict
just how the new approach will work
out. But the American Cancer Society
is conducting other important statistical
studies, and he cited one of them as an
example of future possibilities. A pro-spective
or follow-up study is under
way involving the occurrence of cervical
cancer among more than eighty thou-sand
women in Toledo, Ohio. The main
purpose is to investigate a tentative
finding which, if confirmed, might
mean the saving of many lives.
"Earlier studies had suggested the
existence in the population of a group
of 'high-risk' women—women who re-ported
any kind of cervical complaint
such as discharge or bleeding. Remem-ber
that, as far as medical science can
tell, they were absolutely free of cer-vical
cancer. Yet follow-up observations
indicate that they are 10-to-15 times
more likely to contract the disease than
women who did not have such com-plaints.
Another important point is that
they made up a small proportion of
the total group, about one out of seven
women.
"Now we're checking these results,
among others, with the aid of an elec-tronic
computer and expect to have our
answers within six months or so. As-suming
that our preliminary findings are
indeed valid, we shall make a strenuous
effort to persuade these high-risk wo-men
to report for special medical ex-aminations
every six months. You can
see the possibilities here. Most cer-vical
cancer seems to occur in a group
that can be identified beforehand, and
the chances are good that by focusing
on this group we may be able to lower
death rates appreciably. Furthermore,
our large-scale cancer prevention study
is designed to locate other high-risk
groups, if they exist.
"This may also be the best way to
get back to basic causes, a central aim
of all our research. If high-risk groups
are found and examined two or more
times a year, medical investigators will
have a unique opportunity to follow
more closely than ever before the long
and intricate process whose last stages
are what we call cancer. According to
one theory, the one I favor, this process
depends ultimately on a special kind of
genetic change.
"Think of the body's cells as popula-tions
of living things. They are con-tinually
dying and being replaced by
newborn cells and, as in all popula-tions,
there are mutations or 'sports' in
every new generation. Among the
mutants some cells have the potential
ability to multiply abnormally. They
will not do so, however, unless condi-tions
are right—that is, unless their en-vironment
inside the body is altered in
a suitable way. For example, tobacco
smoke may alter the environment so as
to favor lung-cell mutants capable of
malignant growth at the expense of
normal tissue. A kind of natural selec-tion
may be working in the body, and
our research will help us evaluate this
theory and others."
Toward the end of our talk, Ham-mond
emphasized the widening scope
of the current large-scale survey. The
primary purpose is naturally to cure
and prevent cancer, but a prospective
study by its very nature provides signi-ficant
information about a variety of
conditions. For example, out of the mil-lion
persons originally interviewed five
years ago about forty-five thousand
have already died—and, as expected, a
large proportion of them died from
heart and circulatory diseases. So it is
hardly surprising that results are of con-siderable
interest to specialists in many
fields.
THE HEALTH BULLETIN April, 1965
"An enormous amount of data will
have to be processed here, with im-plications
for the social as well as the
medical sciences. Many of our subjects
have moved, and in tracing them and
obtaining their records we are collect-ing
material about the shift of people
from country to city, about the effects
of migration on health and the family.
In other words, we shall have an in-credibly
large number of associations
of significant relationships to explore.
We receive requests for information
from business schools, sociologists, psy-chologists
and many other sources. But
we have hardly scratched the surface as
far as a full analysis of the data is con-cerned.
That could take another decade,
or another generation.
All Health Is One
"In a fundamental sense, all health
is one nowadays. The battle against
cancer inevitably involves fresh insights
into what it takes to live and be healthy
in a shrinking and increasingly com-plex
world. Evolution has not adapted
us to many of the things we are intro-ducing
into our environment, tensions
as well as drugs and other chemicals.
We must adjust culturally .and a most
important example of that is the con-tinuing
drive to prevent disease and
raise health levels everywhere. This is
the challenge which confronts us all,
and if past successes are any indication,
I believe we can look forward to sig-nificant
progress in the future."
Research Being Done in
Public Health Practices
Progress on organizing research into
the evaluation of public health practices
was reported at the annual meeting of
the American Public Health Association
last year by Dr. Vlado A. Getting. The
paper presented by the Professor of
Public Health Practice at the University
of Michigan's School of Public Health
was developed by members of the mul-tidisciplinary
research team which is
conducting the study under a grant
from the Public Health Service.
Presently-used methods of evaluation
were declared to be of little value be-cause
many depended in large part on
arbitrarily established standards or
measurement of effort which is equated
with accomplishment. Another criticism
was that standards which might be suit-able
in one place or under one set of
circumstances might not be in another.
The study at the University of Michi-gan
was set up, Dr. Getting said, to
work toward: "the development of
tools for the evaluation of program ef-fectiveness,
the exploration of factors
that motivate people to follow health
recommendations, and the identifica-tion
of factors that influence an or-ganization's
ability to make desirable
program changes."
In further definition of the objec-tives
of the study, Dr. Getting stated
the evaluation methods which it
sought to develop should: permit a true
assessment of the extent to which ob-jectives
are attained; be in such form
as to permit a self-evaluation by the
April, 1965 THE HEALTH BULLETIN
operating agency; be applicable to any
public health program regardless of
size or complexity; and reveal the prob-able
source or location of program
weaknesses where such exist.
"Such evaluation devices will permit
different localities to use the same
methodological approach to evaluate
quite different health programs," Dr.
Getting said. "Each locality can assess
what it has achieved with respect to
its own locally defined objectives and
needs."
The task of the study group has been
divided into three steps, Dr. Getting
stated: describe programs in precise
terms as to their objectives; measure
actual accomplishment, bearing in mind
the difficulty of measuring directly some
of the qualities of an objective, and
whether any improvement noted may
be due to causes other than the pro-gram
under consideration; validate
measurement devices by use on exist-ing
programs.
To date, Dr. Getting indicated, the
group's work has consisted mainly of
"developing means of describing pro-gram
objectives and activities in a
manner that will permit subsequent
evaluation." For this purpose a "Guide
for Identification of Program Activities
and Objectives" for use by program
personnel of health agencies has been
developed.
"In this guide," Dr. Getting said, "the
work that constitutes the program to be
evaluated must be locally defined. The
instructions suggest only one caution:
If a program is unusually large and
complex, it may be better to subdivide
it and treat the parts as individual pro-grams."
The agencies are asked to list
program activities and their com-ponents,
and the objectives of each
activity. Definition of objectives is re-quested
in "statements that are precise
and complete enough to permit an ac-curate
measurement of the extent to
which they are being accomplished."
According to Dr. Getting, the expres-sion
of program objective should meet
these requirements: "The statement
must refer to a need, situation or con-dition
that is external to the person or
agency conducting an activity ... It
must be stated with sufficient precision
to indicate both quantitative and quali-tative
aspects of desired outcomes."
Dr. Getting said further that "it may
be necessary to identify the validity of
assumptions that underlie the use of
particular activities to achieve particular
objectives, and the assumptions that
link together the several program ob-jectives
and sub-objectives."
There is a probability, Dr. Getting
said, "other approaches to evaluation
of public health practice, such as the
expert survey technique, will be tested
at some future time."
Several other studies were also men-tioned.
Among these were investiga-tion
of the most effective way of de-termining
people's health beliefs and
their actions to protect their health,
and identification of key factors in-fluencing
health agencies to adapt to
meet changing conditions and needs.
Summing up, Dr. Getting stated that
"the program includes research on the
program effectiveness and on the con-ditions
under which health organiza-tions
are able to modify their programs
and organization in the interest of in-creased
effectiveness. Other research
seeks to throw light on personal de-cision-
making processes in health areas,
and to develop a better understanding
of how people are persuaded to change
their health practices. The research pro-gram
is beginning to produce experi-mental
tools which will have to be field
tested over a period of years but pro-gress
to date indicates that the results
will be useful in the difficult but high-ly
important task of strengthening
community health practices."
10 THE HEALTH BULLETIN April, 1965
Choose
Your
Own
attitude toward their use, says To-day's
Health, the magazine of the
American Medical Association.
Today, hair color is not just accept-able—
it is high fashion, says the mag-azine
article, prepared by a noted der-matologist
and a cosmetic chemist, in
consultation with the Committee on
Cutaneous Health and Cosmetics of the
AMA.
This year Americans are expected to
spend one hundred million dollars on
hair-coloring products. While women
are the principal users, many men also
use hair color.
Hair color can be modified in one of
two ways. The natural pigment of the
hair can be bleached, and thereby light-ened,
or artificial coloring can be ap-plied.
Often both operations are car-ried
out to produce the desired effect.
The importance of reading and ob-serving
the directions for using all
hair-coloring products cannot be over-emphasized.
This is especially true of
IQI* the permanent colors. They are most
difficult to remove. Modern hair-color-ing
products will give excellent results
for most users, but only if the instruc-tions
are carefully followed.
One of the major causes of dissatis-faction
by home users is the mistaken
belief that a single application of hair
color will produce any desired shade.
This is not so. It is quite simple to cover
gray hair or to color light hair a darker
III shade, but it is not yet possible for
a single application of any hair coloring
to change black or dark brown hair to
a pale blond.
Peroxygen compounds, especially
hydrogen peroxide, are widely used in
bleaching hair. Six per cent hydrogen
peroxide solution is the standard
strength, and is safe, if proper pre-cautions
are observed. Stronger concen-
The last few years have seen a flood trations can produce burns and blister-of
new hair-coloring products, and ing of the scalp. Excessive bleaching
hand-in-hand came a change in public can leave the hair harsh, strawlike and
April, 1965 THE HEALTH BULLETIN 11
Coh
of
Hoi
brittle.
Largest and most important group
of hair dyes are those based on
synthetic organic chemicals. These are
in three categories—oxidation dyes,
semi-permanent dyes and temporary
rinses. Oxidation dyes are the most
widely used.
Most professional hair coloring or
tinting is now done with oxidation
dyes, and they also have become pop-ular
for home use. They are the only
products that color the hair quickly
and yet produce all varieties of natural
hair shades which are lasting.
The biggest question about oxida-tion
dyes is their hazard. It has been
estimated that about one person in 50,-
000 will have an unpleasant reaction,
such as a skin rash, swelling about the
eyes, redness and crusting of the face
and neck, plus itching and discomfort.
The victim, while uncomfortable, should
be aware that this is not a serious ill-ness
and that she will recover.
Included with each package, accord-ing
to federal regulations, are instruc-tions
for performing a patch test before
using oxidation dyes, to determine
whether there is an allergy. The test
should be repeated before each applica-tion
of the dye. And the dyes should
not be used on eyebrows or eyelashes,
because of possible danger to the eye.
In addition to the oxidation dyes,
there also are semi-permanent dyes,
which usually will wash out with one
shampoo; acid color rinses, using
harmless organic acids; vegetable dyes,
principally henna, and metallic dyes, no
longer as popular as in the past.
If you decide to change the color of
your hair, and if you decide to do it
yourself rather than seek a professional
job, the important thing to remember
is to read the instructions on the label
and the package insert, and follow
them carefully. These are for your own
safety and protection.
Film On Occupational
Health Is Now Available
The Occupational Health Division of
the U. S. Department of Health, Educa-tion
and Welfare has made available
to the State Board of Health a new
motion picture, "The Hidden Hazards."
This film is obtainable on loan from the
Film Library of the State Board, Box
2091, Raleigh.
"The Hidden Hazards" tells the story
of occupational health. It shows how
man has progressed from the early
trades with obvious dangers, today's
complex operations, in which the haz-ards
may be less evident. See what is
being done to protect employed men
and women from those health hazards
which arise in the course of their work.
Starting on a dramatic note—the near
fatal poisoning of a metal shop worker
-the HIDDEN HAZARDS depicts the
growth of occupational health. The
film traces the change in attitudes and
practices over the years. The apathy of
ancient times, when slaves carried on
the dangerous trades, has gradually
been replaced by action to safeguard
worker health.
Today everyone recognizes that cer-tain
kinds of work are more hazardous
than others. Sometimes the danger
comes from the conditions under which
men work. Sometimes it lies in the
materials they use. Often workers are
surrounded by dangers they cannot see.
Occupational health presents a chal-lenge
of vital concern to all Americans.
It is our hope that this new 28 1/2-
minute, 16 mm, black-and-white, sound
film will be widely used for showings
before civic and fraternal organizations,
women's clubs, and business and labor,
as well as professional, groups. It may
also be of interest to secondary school
students from the standpoint of career
opportunities.
12 THE HEALTH BULLETIN April, 1965
HOPE FOR HEARTS-When the former
Hope Cooke, newly crowned queen of
the tiny Himalayan kingdom of Sikkim,
recently visited her cousin, Mrs. R.
Phillip Hanes of Winston-Salem, alert
Heart Association volunteers posed Her
Majesty with a "Hope for Hearts" post-er.
"Hope for Hearts" is the theme of
the North Carolina 16th Annual Meet-ing
and Scientific Sessions (Durham,
May 20-21) which will feature special
sessions for the general public and lay
Heart Association Volunteers as well as
for family physicians.
DIAL "H" FOR HEART — Five-year-old Sheila Dial, who recently underwent heart
surgery at Duke University Medical Center, receives a surprise visit from North
Carolina's Heart Mother of the Year, Mrs. Walter S. Cobb, herself a "graduate"
of heart surgery. Mrs.
Cobb is one of several
hundred North Carolina
Heart Association Volun-teers
who will be in
Durham on May 20-21
for the State Heart
Group's 16th Annual
Meeting. Looking on,
above right, is Mrs. Mel-vin
Dial, young Sheila's
mother.
April, 1965 THE HEALTH BULLETIN 13
Community Safety
Courses Being
Offered
Educational opportunities at both the
graduate and continued education level
in the field of community safety were
announced recently by the Department
of Public Health Administration, School
of Public Health, University of North
Carolina at Chapel Hill.
Expanding a program initiated three
years ago, the department will enroll
six graduate students in the curriculum
leading to a Master of Public Health
degree for the academic year beginning
September 1965. Up to 30 students will
be accepted for the short course dealing
with program development techniques
in accident control, which will be held
May 31 -June 4, 1965.
"The graduate program is open to
persons from the fields of education,
nursing, engineering, social science,
medicine, and allied fields of interest
who are seeking careers as accident
control specialists in a local, state, or
national health agency or in a private
organization," Dr. Charles Cameron,
Professor and program director, said.
"Through a special grant from the
U. S. Public Health Service, financial
support is available for qualified stu-dents
who are accepted in the master's
program," stated Dr. Cameron. "Inter-ested
persons are urged to contact the
department without delay."
Applications are now being accepted
for the 1965 short course, according to
Miss Janice Westaby, Assistant Profes-sor
and co-director of the program. In-formation
can be obtained by writing
to the Accident Control Program, De-partment
of Public Health Administra-tion,
UNC School of Public Health,
Drawer 229, Chapel Hill, North Caro-lina.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
Lenox D. Baker, M.D., President Durham
John R. Bender, M.D., Vice-President Winston-Salem
Ben W. Dawsey, D.V.M Gastonia
Glenn L. Hooper, D.D.S. Dunn
Oscar S. Goodwin, M.D. Apex
D. T. Redfearn, B.S. Wadesboro
James S. Raper, M.D. Asheville
Samuel G. Koonce, Ph.G. Chadbourn
John S. Rhodes, M.D. Raleigh
EXECUTIVE STAFF
J. W. R. Norton, M.D., M.P.H. State Health Director
Jacob Koomen, Jr., M.D., M.P.H. Assistant State Health Director
J. M. Jarrett, B.S. Director, Sanitary Engineering Division
Martin P. Hines, D.V.M. , M.P.H. Director, Epidemiology Division
W. Burns Jones, M.D., M.P.H. Director, Local Health Division
E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division
Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division
Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division
James F. Donnelly, M.D. Director, Personal Health Division
14 THE HEALTH BULLETIN April, 1965
Pesticides Are
Dangerous—
Follow the Directions
No matter how often you use a pes-ticide—
for home, garden, or farm—or
how well you think you know the di-rections,
READ THE LABEL each time be-fore
you start work and FOLLOW THE
DIRECTIONS EXACTLY. The other im-portant
rule is KEEP PESTICIDES AWAY
FROM CHILDREN.
Other suggestions for safe and sen-sible
use of pesticides are:
1. Use a pesticide only when you are
sure it is needed and then use the
one best suited to your needs. The
label on the product explains the
proper uses.
2. Keep pesticides in plainly labelled
container, preferably the one in
which it was bought. Never trans-fer
pesticides to unlabelled or mis-labelled
containers.
3. Store pesticides under lock and
key away from food items and
OUT OF THE REACH OF CHILDREN,
pets, and people who might not be
able to understand their danger.
4. Avoid inhaling dust and fumes and
avoid getting materials on the skin
when handling, mixing, or apply-ing
pesticides.
5. If there is an accident, most pes-ticide
labels advise washing the
affected area with lots of fresh
water in cases of external exposure.
Check the label of the product
before using so you know what to
do quickly if there is an accident.
Also, call a doctor or get the pa-tient
to a hospital immediately.
6. People who suspect special sen-sitivity
to pesticides should consult
an allergist and, if necessary, take
steps to avoid any exposure to
the offending agent.
7. Wash hands thoroughly after using
pesticides and before eating or
smoking.
8. Get rid of used containers in a
way that will not leave package or
leftover contents as a hazard to
people—particularly children— ani-mals,
or plants.
9. Work in well-ventilated area to
avoid inhalation of fumes.
10. Do not spray into the wind.
11. Wear protective clothing, such as
gloves, aprons, goggles, respira-tors,
and masks, when so directed.
12. Change clothing after each day's
operations and bathe thoroughly.
If clothing or skin become con-taminated,
wash the skin and
change to clean clothing. Wash
contaminated clothes before reus-ing.
13. Avoid the fire hazard caused by
smoking,